HIV Treatment Regimens CDC Guidelines, Pediatric 

Updated: Feb 10, 2017
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; more...
  • Print
Sections

Guidelines per the Centers for Disease Control

The Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection, developed by the HHS Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children were updated in March of 2016.

 

For treatment-naive children, the Panel recommends initiating antiretroviral therapy with three drugs, including either a boosted protease inhibitor, non-nucleoside reverse transcriptase inhibitor, or integrase strand transfer inhibitor plus a dual-nucleoside/nucleotide reverse transcriptase inhibitor backbone. In addition, the development of tenofovir alafenomide (TAF) as an alternative prodrug to tenofovir disoproxil fumarate (TDF) means that TAF-containing regimens should supplant TDF-containing regimens in children, due to concerns regarding decreases in bone mineral density with TDF. The exception to his recommendation is in the context of post-exposure prophyalxis, where TAF remains unstudied, and where the lower plasma concentrations of the drug may actually be a disadvantage.

 

Treatment Guidelines

  • 1 NNRTI + 2 NRTI
  • 1 PI + 2 NRTI
  • 1 INSTI + 2 NRTI

NNRTI

  • non-nucleoside reverse transcriptase inhibitor
  • preferred, ≥ 3 yrs: efavirenz
  • preferred, ≥ 3 yrs: nevirapine
  • alternative:nevirapine

PI

  • protease inhibitor
  • preferred: lopinavir + ritonavir
  • alternative, ≥ 6 yrs: atazanavir + ritonavir (low dose), fosamprenavir + ritonavir (low dose)
  • alternative, ≥ 2 yrs: nelfinavir

INSTI

  • Integrase Strand Transfer Inhibitor
  • preferred, >2yo to 12yo; raltegravir chewables or film-coated tablets
  • preferred, >12yo and >40mg: dolutegravir
  • preferred, ≥ 12 years and weighing ≥35 kg: elvitegravir ONLY in the fixed dose combination elvitegravir/cobicistat/emtricitabine/TAF
  • alternative, 4 weeks to 2yo: raltegravir granules

Dual-NRTI

  • nucleoside reverse transcriptase inhibitor
  • preferred: abacavir + (lamivudine or emtricitabine), didanosine + emtricitabine, tenofovir + (lamivudine or emtricitabine), zidovudine + (lamivudine or emtricitabine)
  • alternative: abacavir + zidovudine, zidovudine + didanosine