Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life

Abstract

The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV-1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short-term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long-term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first- and second-line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART 'pipeline' of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.

Keywords: HIV-1; antiretroviral therapy; child.

Figure 1

Predicted long‐term CD4 count following antiretroviral therapy (ART) initiation at thresholds of 250, 350, 500, 750 and 1000 cells/μL (curves), using models derived from the AntiRetroviral Research for Watoto (ARROW) study. Delaying treatment in children younger than 5 years (to the left of the vertical line) results in relatively small differences in long‐term expected CD4 count. In contrast, children aged over 5 years (right of the vertical line) are predicted to experience a steady deterioration in long‐term CD4 count as ART is initiated at increasingly older ages (and a constant CD4 threshold). Dashed lines show that a 6‐year‐old delaying treatment until the age of 13 years, with a CD4 count of 350 cells/μL throughout, may expect the long‐term CD4 count to be lowered by 151 cells/μL: from 770 to 619 cells/μL.