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Pediatric HIV Infection Medication

  • Author: Delia M Rivera, MD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Apr 07, 2016
 

Medication Summary

Antiretroviral drugs (ARDs) are used for the treatment of human immunodeficiency virus (HIV) infection and for postexposure prophylaxis (PEP). ARD monotherapy does not produce sustained clinical benefits, such as improved survival. This failure is partly due to the development of drug-resistant variants of HIV. Resistance develops rapidly during monotherapy, and cross-resistance among related drugs is common.

Combination therapy with ARDs (a strategy analogous to the treatment of TB and other infectious diseases) has improved efficacy, minimized toxicity, and delayed drug resistance.

Six classes of ARDs currently exist, as follows:

  • Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs)
  • Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
  • Protease inhibitors (PIs)
  • Integrase inhibitors (IIs)
  • Fusion inhibitors (FIs)
  • Chemokine receptor antagonists (CRAs)

Initial therapy should be started with a combination of 3 ARDs, including a backbone of 2 NRTIs plus  an NNRTI, or 2 NRTIs plus  a protease inhibitor.[3]

As of January 2016, more than 19 ARDs have been approved for pediatric usage and more than 15 are available as a pediatric formulation or capsule size.

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Nucleoside or Nucleotide Reverse Transcriptase Inhibitors

Class Summary

NRTIs are nucleoside or nucleotide reverse transcriptase inhibitor analogs with antiretroviral activity. They are indicated for the treatment of HIV infection, and they delay the progression of the disease.

Abacavir (ABC, Ziagen)

 

Patients and parents must be cautioned about the risk of serious hypersensitivity reaction. Provide a medication guide and warning card.

Didanosine (ddI, dideoxyinosine, Videx, Videx EC)

 

This agent is a purine nucleoside analog with antiviral activity.

Lamivudine (3TC, Epivir, Epivir HBV)

 

Lamivudine is a dideoxynucleoside analog with antiretroviral activity. In combination with oral zidovudine, it produces substantial and sustained increases in CD4+ counts and decreases in viral load in HIV-infected patients. It is also approved by the US Food and Drug Administration (FDA) to treat hepatitis B.

Stavudine (d4T, Zerit)

 

Stavudine is a synthetic thymidine nucleoside analog active against HIV-1.

Zidovudine (ZDV, AZT, Retrovir)

 

This agent is a thymidine analog that inhibits viral replication. It inhibits activity of HIV reverse transcriptase by competing with natural substrate for use by and incorporation into viral DNA.

Emtricitabine (FTC, Emtriva)

 

A synthetic nucleoside cytosine analog, emtricitabine competes with deoxycytidine-5'-triphosphate and incorporates into viral DNA, causing chain termination.

Tenofovir (TDF, Viread)

 

This antiretroviral agent used in treatment of AIDS inhibits activity of HIV reverse transcriptase by competing with natural substrate deoxyadenosine 5'-triphosphate and, after incorporation into DNA, by causing DNA chain termination. It is administered as prodrug bis-isopropoxycarbonyloxymethyl ester derivative of tenofovir, which is converted, in various enzymatic processes, to tenofovir, an acyclic nucleoside phosphonate (nucleotide) analog of adenosine 5'-monophosphate.

Administration with a high-fat meal enhances bioavailability. Prolonged intracellular levels allows for once-daily dosing.

Etravirine (Intelence)

 

Indicated in combination with other antiretroviral agents (ART) for treatment of HIV-1 infection in ART-experienced patients with evidence of viral replication and HIV-1 strains resistant to a NNRTIs and other antiretroviral agents.

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Nonnucleoside Reverse Transcriptase Inhibitors

Class Summary

NNRTIs inhibit both DNA-directed and RNA-directed polymerase functions of HIV-1 reverse transcriptase. The different sites of action of nonnucleoside and nucleoside inhibitors suggest potential synergistic effects of these agents and their potential activity against nucleoside-resistant HIV strains.

Delavirdine (DLV, Rescriptor)

 

Delavirdine is a potent NNRTI used primarily in combination regimens.

Efavirenz (DMP-266, EFV, Sustiva)

 

Efavirenz is used only in combination regimens.

Nevirapine (NVP, Viramune, Viramune XR)

 

Nevirapine is indicated for use in combination with other ARDs for treatment of HIV-1 infection.

Rilpivirine (Edurant)

 

NNRTI indicated in combination with other ARTs for treatment of HIV-1 infection in treatment-naïve adolescents aged 12-17 y with HIV-1 RNA ≤100,000 copies/mL.

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Protease Inhibitors

Class Summary

Protease inhibitors inhibit HIV protease, which is required for HIV replication and the formation of mature, infectious viral particles.

Indinavir (Crixivan, IDV)

 

This agent prevents formation of protein precursors necessary for HIV infection of uninfected cells and viral replication.

Nelfinavir (Viracept, NPV)

 

Nelfinavir inhibits HIV-1 protease, resulting in the production of an immature and noninfectious virus.

Ritonavir (Norvir, RTV)

 

Ritonavir is an HIV protease inhibitor used as part of double or triple therapy with nucleosides and other protease inhibitors.

Saquinavir (SQV, Invirase)

 

Saquinavir is an HIV protease inhibitor used as part of double or triple therapy with nucleosides and other protease inhibitors. It is available as a 200-mg hard gel cap or 500-mg film-coated tablet.

Lopinavir and ritonavir (Kaletra, LVP/r)

 

Lopinavir inhibits HIV protease and renders enzyme incapable of processing polyprotein precursors, leading to production of noninfectious, immature HIV particles. Ritonavir inhibits CYP3A metabolism of lopinavir, increasing plasma levels. This product is available in tablets (200 mg/50 mg LPV/r), pediatric tablets (100 mg/25 mg LPV/r), and PO solution (80 mg/20 mg LPV/r; 42.4% alcohol by volume).

Atazanavir (ATV, Reyataz)

 

Atazanavir is an azapeptide HIV-1 protease inhibitor. It prevents virion maturation by selectively inhibiting Gag and Gag-Pol polyproteins in HIV-1 infected cells.

Darunavir (DRV, TMC-114, Prezista)

 

An HIV-1 protease inhibitor, darunavir selectively inhibits HIV-encoded Gag-Pol polyprotein cleavage in infected cells, preventing formation of mature virus particles. It is indicated to treat HIV disease not responding to other ARDs. Coadminister with low-dose ritonavir (ritonavir-boosted therapy decreases elimination and increases darunavir serum concentration).

Darunavir is typically coadministered with other anti-HIV agents (eg, NRTIs). Food increases maximum concentration (Cmax) and area under the concentration-time curve (AUC). It is indicated to treat HIV infection in ART–experienced adults (eg, those with HIV-1 strains resistant to >1 protease inhibitor).

Fosamprenavir (f-APV, Lexiva)

 

A prodrug of amprenavir (inhibitor of HIV protease), fosamprenavir is rapidly converted to amprenavir by cellular phosphatases in vivo. Amprenavir inhibits HIV-1 protease and binds its active site, preventing the processing of viral Gag and Gag-Pol polyprotein precursors and resulting in immature, noninfectious viral particles.

Tipranavir (TPV, Aptivus)

 

A nonpeptidic protease inhibitor, tipranavir inhibits HIV replication. It is indicated for combination ART of HIV-1 infection in adults with evidence of viral replication and who are highly treatment experienced or who have strains resistant to several protease inhibitors. This agent must be coadministered with ritonavir 200 mg to attain therapeutic levels. It is ineffective if used alone without ritonavir-boosted levels. Results of genotypic or phenotypic testing and/or treatment history should guide use. It is available as 250 mg caps or as PO solution of 100 mg/mL.

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Entry and Fusion Inhibitors

Class Summary

These agents disrupt HIV binding and, ultimately, fusion with host cells. Entry inhibitors bind to CCR5 chemokines coreceptors. Fusion inhibitors bind to the HR1 region of gp41.

Enfuvirtide (T-20, Fuzeon)

 

Enfuvirtide is the sole available fusion inhibitor. It blocks entry of HIV into human immune cells by inhibiting gp41 protein, disrupting viral structural rearrangement to fuse with healthy immune cells and preventing HIV replication. In clinical trials, selected patients with multidrug resistance were twice as likely to achieve undetectable HIV-1 plasma levels (< 40 copies/mL) when enfuvirtide was added to optimized antiretroviral regimens.

Maraviroc (MVC, Selzentry)

 

Maraviroc blocks viral entry via CCR5 co-receptor into host cells, reduces viral load, and increases T-cell counts in CCR5-tropic HIV-1 (ie, R5 virus). This agent is indicated for combination treatment with optimized background therapy in treatment-experienced adults infected with only R5 virus who have evidence of viral replication and have HIV-1 strains resistant to multiple antiretroviral agents.

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Integrase Inhibitors

Class Summary

HIV integrase is responsible for the transport and attachment of proviral DNA to host-cell chromosomes, allowing transcription of viral proteins.

Raltegravir (RAL, Isentress)

 

Raltegravir is an HIV-1integrase strand transfer inhibitor (INSTI). It is indicated for use in combination therapy regimens for the treatment of HIV infection.

Dolutegravir (Tivicay)

 

Dolutegravir is an integrase strand transfer inhibitor (INSTI) that inhibits catalytic activity of HIV-1 integrase, an HIV encoded enzyme required for viral replication. It is approved for use in children 12 years or older who weigh at least 40 kg.

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HIV, ART Combos

Class Summary

Combination ARTs are helpful to promote compliance with complex medication regimens.

Emtricitabine/tenofovir/efavirenz (Atripla)

 

Contains emtricitabine and tenofovir (NRTIs), plus efavirenz (NNRTI).

Elvitegravir/cobicistat/emtricitabine/tenofovir AF (Genvoya)

 

Four-drug antiretroviral (ART) combination of elvitegravir (integrase strand transfer inhibitor [INSTI]), cobicistat (CYP3A inhibitor), and emtricitabine and tenofovir alafenamide (TAF), both nucleoside analog reverse transcriptase inhibitors (NRTIs). It is indicated as a complete treatment regimen for HIV-1 infection in adults and children aged ≥12 y (weight ≥35 kg) who are ART-naïve or to replace the current ART regimen in those who are virologically suppressed (HIV-1 RNA <50 copies/mL) on a stable ART regimen for at least 6 months with no history of treatment failure and no known substitutions associated with resistance to the individual components.

Emtricitabine/rilpivirine/tenofovir DF (Complera)

 

Indicated as complete regimen for treatment of HIV-1 infection in treatment-naïve adults and adolescents aged 12 years or older (weight ≥35 kg) with HIV-1 RNA >100,000 copies/mL, and in certain virologically-suppressed (HIV-1 RNA <50 copies/mL) patients on a stable ART regimen at start of therapy in order to replace their current ART regimen. Combination consists of 2 NRTIs (ie, emtricitabine and tenofovir) and 1 NNRTI (ie, rilpivirine).

Emtricitabine/tenofovir AF (Descovy)

 

NRTI combination product. Indicated in combination with other ART agents (eg, NNRTIs, PIs) for the treatment of HIV-1 infection in adults and pediatric patients aged 12 y or older. Tenofovir alafenamide (AF) is a more targeted form of tenofovir that has demonstrated high antiviral efficacy at a dose that is 10 times lower than tenofovir DF, as well as an improved renal and bone safety profile.

Emtricitabine/tenofovir DF (Truvada)

 

Indicated, in combination with other antiretroviral agents (eg, NNRTIs, PIs), for the treatment of HIV-1 infection in adults and pediatric patients who weigh at least 17 kg and can swallow the tablet whole.

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Contributor Information and Disclosures
Author

Delia M Rivera, MD Assistant Professor, Department of Pediatrics, Division of Infectious Disease and Immunology, University of Miami Leonard M Miller School of Medicine

Delia M Rivera, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Richard E Frye, MD, PhD Associate Professor, Department of Pediatrics, University of Arkansas for Medical Sciences

Richard E Frye, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, International Neuropsychological Society, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Mark Abdelmalek, MD Chief, Division of Laser and Dermatologic Surgery, Assistant Professor, Department of Dermatology, Drexel University College of Medicine

Mark Abdelmalek, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, Pennsylvania Academy of Dermatology, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Kathleen B Elmer, MD Consulting Staff, Department of Dermatology, First Medical Group, Langley Air Force Base

Disclosure: Nothing to disclose.

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Michael Loosemore, MD Fellow in Dermatological Surgery, The Methodist Hospital

Michael Loosemore, MD is a member of the following medical societies: American Academy of Dermatology, Massachusetts Medical Society, and Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. Brooks M. Study supports earlier initiation of HAART in HIV-infected children. Medscape Medical News. October 2, 2014. [Full Text].

  2. Yin DE, Warshaw MG, Miller WC, Castro H, Fiscus SA, Harper LM, et al. Using CD4 percentage and age to optimize pediatric antiretroviral therapy initiation. Pediatrics. 2014 Oct. 134(4):e1104-16. [Medline].

  3. [Guideline] The Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the use of antiretroviral agents in pediatric HIV infection. AIDSinfo. Available at https://aidsinfo.nih.gov/guidelines/html/2/pediatric-treatment-guidelines/0. March 5, 2015; Accessed: January 15, 2016.

  4. Prevalence and awareness of HIV infection among men who have sex with men --- 21 cities, United States, 2008. MMWR Morb Mortal Wkly Rep. 2010 Sep 24. 59(37):1201-7. [Medline].

  5. Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths - United States. MMWR Morb Mortal Wkly Rep. 2012 Nov 30. 61(47):971-6. [Medline]. [Full Text].

  6. World Health Organization. Paediatric HIV and treatment of children living with HIV. Available at http://www.who.int/hiv/paediatric/en/index.html. Accessed: June 22, 2011.

  7. World Health Organization. Global summary of the AIDS epidemic: 2009. Available at http://www.who.int/hiv/data/2009_global_summary.png. Accessed: June 21, 2011.

  8. UNAIDS Report on the Global AIDS Epidemic 2010. Available at http://www.unaids.org/globalreport/Global_report.htm. Accessed: June 21, 2011.

  9. World Health Organization. Strategic Vision. World Health Organization. Available at http://www.who.int/hiv/pub/mtct/strategic_vision.pdf. Accessed: June 21, 2011.

  10. Centers for Disease Control and Prevention. Achievements in public health. Reduction in perinatal transmission of HIV infection--United States, 1985-2005. MMWR Morb Mortal Wkly Rep. 55(21):592-7. [Medline]. [Full Text].

  11. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2004. US Department of Health and Human Services, Centers for Disease Control and Prevention. 2005. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2004report/pdf/2004SurveillanceReport.p.

  12. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. National vital statistics reports; vol 58 no 19. Hyattsville, MD: National Center for Health Statistics. 2010. Available at http://www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf. Accessed: June 21, 2011.

  13. Garrib A, Jaffar S, Knight S, Bradshaw D, Bennish ML. Rates and causes of child mortality in an area of high HIV prevalence in rural South Africa. Trop Med Int Health. 2006 Dec. 11(12):1841-8. [Medline].

  14. Preidis GA, McCollum ED, Mwansambo C, Kazembe PN, Schutze GE, Kline MW. Pneumonia and malnutrition are highly predictive of mortality among African children hospitalized with human immunodeficiency virus infection or exposure in the era of antiretroviral therapy. J Pediatr. 2011 Sep. 159(3):484-9. [Medline].

  15. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: Preliminary Data for 2009. National Vital Statistics Reports. DHHS, National Center for Health Statistics. 2011. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_04.pdf.

  16. Guidelines for the use of antiretroviral agents in pediatric HIV infection. Center for Disease Control and Prevention. MMWR Recomm Rep. 1998 Apr 17. 47:1-43. [Medline].

  17. Chiou CC, Groll AH, Gonzalez CE, Callender D, Venzon D, Pizzo PA, et al. Esophageal candidiasis in pediatric acquired immunodeficiency syndrome: clinical manifestations and risk factors. Pediatr Infect Dis J. 2000 Aug. 19(8):729-34. [Medline].

  18. Brown DM, Jabra-Rizk MA, Falkler WA Jr, Baqui AA, Meiller TF. Identification of Candida dubliniensis in a study of HIV-seropositive pediatric dental patients. Pediatr Dent. 2000 May-Jun. 22(3):234-8. [Medline].

  19. Shapiro RL, Hughes MD, Ogwu A, Kitch D, Lockman S, Moffat C, et al. Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med. 2010 Jun 17. 362(24):2282-94. [Medline].

  20. Lipshultz SE, Shearer WT, Thompson B, et al. Cardiac effects of antiretroviral therapy in HIV-negative infants born to HIV-positive mothers: NHLBI CHAART-1 (National Heart, Lung, and Blood Institute Cardiovascular Status of HAART Therapy in HIV-Exposed Infants and Children cohort study). J Am Coll Cardiol. 2010 Dec 28. 57(1):76-85. [Medline].

  21. Dias EP, Israel MS, Silva Junior A, Maciel VA, Gagliardi JP, Oliveira RH. Prevalence of oral hairy leukoplakia in 120 pediatric patients infected with HIV-1. Braz Oral Res. 2006 Apr-Jun. 20(2):103-7. [Medline].

  22. Mohle-Boetani JC, Koehler JE, Berger TG, LeBoit PE, Kemper CA, Reingold AL, et al. Bacillary angiomatosis and bacillary peliosis in patients infected with human immunodeficiency virus: clinical characteristics in a case-control study. Clin Infect Dis. 1996 May. 22(5):794-800. [Medline].

  23. Perry RT, Mmiro F, Ndugwa C, Semba RD. Measles infection in HIV-infected African infants. Ann N Y Acad Sci. 2000 Nov. 918:377-80. [Medline].

  24. Enwonwu CO, Falkler WA Jr, Idigbe EO, Savage KO. Noma (cancrum oris): questions and answers. Oral Dis. 1999 Apr. 5(2):144-9. [Medline].

  25. Jaquet D, Lévine M, Ortega-Rodriguez E, Faye A, Polak M, Vilmer E, et al. Clinical and metabolic presentation of the lipodystrophic syndrome in HIV-infected children. AIDS. 2000 Sep 29. 14(14):2123-8. [Medline].

  26. Chiarelli F, Galli L, Verrotti A, di Ricco L, Vierucci A, de Martino M. Thyroid function in children with perinatal human immunodeficiency virus type 1 infection. Thyroid. 2000 Jun. 10(6):499-505. [Medline].

  27. Smith KJ, Skelton HG 3rd, Vogel P, Yeager J, Baxter D, Wagner KF. Exaggerated insect bite reactions in patients positive for HIV. Military Medical Consortium for the Advancement of Retroviral Research. J Am Acad Dermatol. 1993 Aug. 29(2 Pt 1):269-72. [Medline].

  28. Kest H, Brogly S, McSherry G, Dashefsky B, Oleske J, Seage GR 3rd. Malignancy in perinatally human immunodeficiency virus-infected children in the United States. Pediatr Infect Dis J. 2005 Mar. 24(3):237-42. [Medline].

  29. Pongsiriwet S, Iamaroon A, Kanjanavanit S, Pattanaporn K, Krisanaprakornkit S. Oral lesions and dental caries status in perinatally HIV-infected children in Northern Thailand. Int J Paediatr Dent. 2003 May. 13(3):180-5. [Medline].

  30. Ziegler JL, Katongole-Mbidde E. Kaposi's sarcoma in childhood: an analysis of 100 cases from Uganda and relationship to HIV infection. Int J Cancer. 1996 Jan 17. 65(2):200-3. [Medline].

  31. Tofsky N, Nelson EM, Lopez RN, Catalanotto FA, Fine DH, Katz RV. Dental caries in HIV-infected children versus household peers: two-year findings. Pediatr Dent. 2000 May-Jun. 22(3):207-14. [Medline].

  32. [Guideline] Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006 Sep 22. 55:1-17; quiz CE1-4. [Medline]. [Full Text].

  33. Committee opinion no: 635: prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol. 2015 Jun. 125 (6):1544-7. [Medline].

  34. Skwarecki B. ACOG updates recommendations for prenatal HIV testing. Medscape Medical News. Available at http://www.medscape.com/viewarticle/845416. May 27, 2015; Accessed: June 25, 2015.

  35. Adolescents and HIV Infection: The Pediatrician's Role in Promoting Routine Testing. Pediatrics. 2011 Nov. 128(5):1023-9. [Medline].

  36. [Guideline] Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. AIDSinfo. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf. Accessed: December 23, 2013.

  37. [Guideline] Mofenson LM, Brady MT, Danner SP, Dominguez KL, Hazra R, Handelsman E, et al. Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. MMWR Recomm Rep. 2009 Sep 4. 58:1-166. [Medline]. [Full Text].

  38. Violari A, Cotton MF, Gibb DM, Babiker AG, Steyn J, Madhi SA, et al. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008 Nov 20. 359(21):2233-44. [Medline]. [Full Text].

  39. Cotton M, Cassim H, Pavía-Ruz N, Garges HP, Perger T, Ford SL, et al. Pharmacokinetics, safety and antiviral activity of fosamprenavir/ritonavir-containing regimens in HIV-infected children aged 4 weeks to 2 years- 48 week study data. Pediatr Infect Dis J. 2013 Jul 9. [Medline].

  40. Frange P, Briand N, Avettand-Fenoel V, et al. Lopinavir/Ritonavir-based Antiretroviral Therapy in Human Immunodeficiency Virus Type 1-infected Naive Children: Rare Protease Inhibitor Resistance Mutations But High Lamivudine/Emtricitabine Resistance at the Time of Virologic Failure. Pediatr Infect Dis J. 2011 Aug. 30(8):684-8. [Medline].

  41. Lowes R. Tivicay Approved to Treat HIV-1 Infection. Medscape Medical News. Aug 12 2013. [Full Text].

  42. FDA. FDA approves new drug to treat HIV infection. Aug 12 2013. [Full Text].

  43. US Food and Drug Administration. New Isentress (raltegravir) dosage form: oral suspension. December 20, 2013. Available at http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/HIVandAIDSActivities/ucm379632.htm. Accessed: January 13, 2014.

  44. Merck & Co, Inc. Merck receives FDA Approval for Isentress (raltegravir) for pediatric oral suspension. January 8, 2014. Available at http://www.mercknewsroom.com/news-release/prescription-medicine-news/merck-receives-fda-approval-isentress-raltegravir-pediatric-. Accessed: January 13, 2014.

  45. Brooks M. FDA clears new formulation of raltegravir for infants. Medscape Medical News. January 9, 2014. [Full Text].

  46. Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir AF) [package insert]. Foster City, CA: Gilead Sciences, Inc. November 2015. Available at [Full Text].

  47. Complera (emtricitabine/rilpivirine/tenofovir DF) [package insert]. Foster City, CA: Gilead Sciences, Inc. February 2016. Available at [Full Text].

  48. Chasela CS, Hudgens MG, Jamieson DJ, Kayira D, Hosseinipour MC, Kourtis AP, et al. Maternal or infant antiretroviral drugs to reduce HIV-1 transmission. N Engl J Med. 2010 Jun 17. 362(24):2271-81. [Medline].

  49. Coovadia HM, Brown ER, Fowler MG, et al. Efficacy and safety of an extended nevirapine regimen in infant children of breastfeeding mothers with HIV-1 infection for prevention of postnatal HIV-1 transmission (HPTN 046): a randomised, double-blind, placebo-controlled trial. Lancet. 2012 Jan 21. 379(9812):221-8. [Medline].

  50. van Dijk JH, Sutcliffe CG, Hamangaba F, Bositis C, Watson DC, Moss WJ. Effectiveness of Efavirenz-Based Regimens in Young HIV-Infected Children Treated for Tuberculosis: A Treatment Option for Resource-Limited Settings. PLoS One. 2013. 8(1):e55111. [Medline]. [Full Text].

  51. Treating HIV-infected People with Antiretrovirals Protects Partners from Infection: Findings Result from NIH-funded International Study. News release May 12, 2011. Available at http://www.niaid.nih.gov/news/newsreleases/2011/pages/hptn052.aspx.

  52. Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, et al. Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand. N Engl J Med. 2009 Dec 3. 361(23):2209-20. [Medline].

  53. Benjamin DK Jr, Miller WC, Benjamin DK, Ryder RW, Weber DJ, Walter E, et al. A comparison of height and weight velocity as a part of the composite endpoint in pediatric HIV. AIDS. 2003 Nov 7. 17(16):2331-6. [Medline].

  54. Brooks M. Efavirenz Gets Expanded Indication for HIV. Medscape Medical News. Available at http://www.medscape.com/viewarticle/803701. Accessed: May 15, 2013.

  55. [Guideline] World Health Organization. HIV and Infant Feeding. Revised Principles and Recommendations. World Health Organization. Available at http://whqlibdoc.who.int/publications/2009/9789241598873_eng.pdf. Accessed: June 29, 2011.

 
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Genome layout of human immunodeficiency virus (HIV)–1 and HIV-2.
Table 1. CDC Immunologic Categories for HIV-Infection in Children Based on Absolute CD4 + Counts
Category  
< 1 y 1-5 y 6-12 y
1 - No suppression ≥1500 (>25) ≥1000 (>25) ≥500 (>25)
2 - Moderate suppression 750-1499 (15-24) 500-999 (15-24) 200-499 (15-24)
3 - Severe suppression < 750 (< 15) < 500 (< 15) < 200 (< 15)
Table 2. Antibiotics for Primary and Secondary Prophylaxis of Opportunistic Infections
Infection Indication First-Line Regimen Alternative Regimen
TB PPD test result >5 mm Isoniazid and pyridoxine qd for 9 mo Rifampin for 4 mo
Exposure Isoniazid and pyridoxine 3 times/wk for 9 mo, rifampin and pyrazinamide qd for 2 mo Consult an infectious diseases specialist if the pathogen is multidrug resistant
PCP CD4+ finding* Trimethoprim-sulfamethoxazole qd Trimethoprim-sulfamethoxazole 3 times/wk
Fever of unknown origin for 2 wk, history of infection Dapsone, pyrimethamine, and leucovorin Dapsone or aerosolized pentamidine in children >5 y
--- Atovaquone Atovaquone
Toxoplasmosis CD4+ count < 100 cells/mL Trimethoprim-sulfamethoxazole qd Dapsone, pyrimethamine, and leucovorin
Positive immunoglobulin G finding None Atovaquone
Previous infection Sulfadiazine, pyrimethamine, and leucovorin Clindamycin, pyrimethamine, and leucovorin
MAC infection CD4+ finding** Azithromycin qwk Rifabutin qd or clarithromycin bid
Previous infection Clarithromycin or azithromycin qd and ethambutol Clarithromycin or azithromycin qd and ethambutol
Abbreviations: bid = twice daily; PPD = purified protein derivative; qd = every day; qwk = every week.



* See Table 4



**See Table 5



Table 3. Drugs and Doses for Prophylaxis of Opportunistic Infections
Drug Dose
Azithromycin 20 mg/kg/dose (1.2 g maximum) PO qwk or



5 mg/kg/dose (250 mg maximum) PO qd



Clarithromycin 7.5 mg/kg/dose (500 mg maximum) PO bid
Clindamycin 20-30 mg/kg/d PO qid
Dapsone 1-2 mg/kg/d (100 mg maximum) PO qd
Ethambutol 15 mg/kg/dose (900 mg maximum) PO qd
Isoniazid 10-15 mg/kg/dose (300 mg maximum) PO/IM qd
Leucovorin 5 mg PO 3 times/wk
Pentamidine 4 mg/kg/dose monthly
Pyrimethamine 15 mg/m2/dose (25 mg maximum) PO qd
Rifabutin 5 mg/kg/dose (300 mg maximum) PO qd
Rifampin 10-20 mg/kg (600 mg maximum) PO/IV qd
Sulfadiazine 85-120 mg/kg/d PO bid
Trimethoprim-sulfamethoxazole 150/750 mg/m2/d PO bid
Abbreviations: bid = twice daily; PO = by mouth; qd = every day; qwk = every week.
Table 4. CD4 + -Based Indications for Starting PCP Prophylaxis
Age or Status CD4+ Count, cells/mL CD4+ Percentage
6 wk to 1 y Any Any
1-2 y < 750 < 15
2-5 y < 500 < 15
>5 y < 200 < 15
Previous PCP infection Any Any
Table 5. CD4 + -Based Indications for MAC Prophylaxis
Age or Status CD4+ Count, Cells/mL
< 1y < 750
1-2 y < 500
2-6 y < 75
> 6 y < 50
Previous infection Any
Table 6. Risk Factors for Vertical Transmission
Period Factors That Increase Risk Factors That Decrease Risk
Prenatal Acute HIV infection



Viral load >10,000



Cigarette smoking



Illicit IV drug use



Viral load < 1000



Zidovudine treatment



Neutralizing antibodies



Perinatal Rupture of membranes for >4 h



Chorioamnionitis



Emergency cesarean delivery



Surgical delivery



Episiotomy



Use of scalp electrodes



Elective cesarean delivery with zidovudine treatment
Neonatal Prematurity



Low birth weight



First-born twin



Full-term



Second-born twin



Postdelivery Breastfeeding ART
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