Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach

Excerpt

These treatment guidelines serve as a framework for selecting the most potent and feasible first-line and second-line ART regimens for the care of HIV-infected infants and children.

These guidelines address the diagnosis of HIV infection and consider ART in different situations, e.g. where infants and children are coinfected with HIV and TB, or have been exposed to ARVs, either for PMTCT or because of breastfeeding from an HIV-infected mother on ART. In addition, these guidelines address the importance of nutrition in the HIV-infected child and of recognizing the severity of malnutrition, especially in relation to the provision of ART. Adherence to therapy and resistance to ARVs are discussed. A section on ART in adolescents briefly outlines key issues related to treatment and care for this age group.

WHO recognizes the need to strengthen health systems with a view to maximizing the quality and long-term benefits of ART. Improved access to HIV diagnostic testing for infants and children is necessary to save lives. The inability to diagnose HIV infection as early as possible in infants and children severely limits access to ART and its timely initiation. Reliable access to immunological assays for assessing CD4 levels in children is crucial for guiding the initiation of treatment and for optimizing the maintenance of ART.

These guidelines are intended primarily for use by treatment advisory boards, national AIDS programme managers and other senior policy-makers who are involved in the planning of national and international HIV care strategies for infants and children in resource-limited countries. Elements of the guidelines such as the simplified dosing guidance (Annex E) are also designed for clinical implementation in the field.