Book contents
- Frontmatter
- Contents
- List of contributors
- List of abbreviations
- Foreword
- Preface
- Introduction
- Part I Scientific basis of pediatric HIV care
- Part II General issues in the care of pediatric HIV patients
- Part III Antiretroviral therapy
- 18 Antiretroviral therapy
- 19 Antiretroviral drug interactions
- 20 Metabolic complications of antiretroviral therapy in children
- 21 HIV drug resistance
- 22 Initiating and changing antiretroviral therapy
- 23 Therapeutic drug monitoring
- 24 HIV postexposure prophylaxis for pediatric patients
- Part IV Clinical manifestations of HIV infection in children
- Part V Infectious problems in pediatric HIV disease
- Part VI Medical, social, and legal issues
- Appendices
- Index
- Plate section
- References
22 - Initiating and changing antiretroviral therapy
from Part III - Antiretroviral therapy
Published online by Cambridge University Press: 03 February 2010
- Frontmatter
- Contents
- List of contributors
- List of abbreviations
- Foreword
- Preface
- Introduction
- Part I Scientific basis of pediatric HIV care
- Part II General issues in the care of pediatric HIV patients
- Part III Antiretroviral therapy
- 18 Antiretroviral therapy
- 19 Antiretroviral drug interactions
- 20 Metabolic complications of antiretroviral therapy in children
- 21 HIV drug resistance
- 22 Initiating and changing antiretroviral therapy
- 23 Therapeutic drug monitoring
- 24 HIV postexposure prophylaxis for pediatric patients
- Part IV Clinical manifestations of HIV infection in children
- Part V Infectious problems in pediatric HIV disease
- Part VI Medical, social, and legal issues
- Appendices
- Index
- Plate section
- References
Summary
Introduction
Guidelines for antiretroviral therapy in children must incorporate considerations unique to pediatric HIV infection. Such considerations include: age-related changes in drug pharmacokinetics; issues related to diagnosis of perinatal infection (early diagnosis permits therapy to be initiated during primary HIV infection); normal age-related changes in immunologic parameters; differences between children and adults in the natural history of HIV infection (i.e. differences in virologic parameters during primary infection, in the rapidity of disease progression, and in the frequency of central nervous system (CNS) and growth abnormalities); prior antiretroviral exposure of newly infected infants (in utero and neonatal exposure to drugs used for maternal treatment and transmission prophylaxis); and pediatric-specific adherence issues (i.e. availability and palatability of drug formulations; relationship of drug administration to food intake in young infants; dependence on caregiver for administration of drugs).
Prospective, randomized, controlled clinical trials offer the best evidence for formulation of guidelines. However, most antiretroviral drugs are approved for use in pediatric patients based on efficacy data from clinical trials in adults, with supporting pharmacokinetic and safety data from phase I/II trials in children; additionally, efficacy in most adult trials has been based on surrogate marker data, as opposed to clinical endpoints. Thus, guidelines for treatment of HIV-infected children often have to rely on data regarding virologic/immunologic response to drug regimens in adult clinical trials, taking into account the specific considerations in pediatric HIV infection delineated above, and with attention to data from pediatric populations when available.
- Type
- Chapter
- Information
- Textbook of Pediatric HIV Care , pp. 355 - 376Publisher: Cambridge University PressPrint publication year: 2005