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MANAGEMENT OF HIV INFECTION IN CHILDREN d) Adolescents The following recommendations are adapted from the US Department of Health and Human Services Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults & Adolescents. 177,Level 9 Adult guidelines for ART are considered appropriate for post pubertal adolescents. Recommendation first-line antiretroviral drugs (adolescents) The standard of care is HAART which comprises: 2 NRTI plus 3rd active agent (NNRTI based or PI based). Preferred Agent # Alternative Agent* NNRTI based : Efavirenz Nevirapine PI Based: Lopinavir/ ritonavir Atazanavir NRTI combinations Preferred Combination* Alternative Combination* Zidovudine + Lamivudine Didanosine + Lamivudine (co- formulated) (Grade C) Preferred agents # or combinations for use in treatment-naive patients are those where clinical trial data have demonstrated optimal efficacy and durability with acceptable tolerability and ease of use. Alternative* components refer to those for which clinical trial data efficacy but also show disadvantages compared with preferred components in terms of antiviral activity, durability, tolerability, or ease of use. Refer to Appendix 4 for details on individual ARV drugs Efavirenz is not recommended for use in the 1st trimester of pregnancy or in sexually active women with child-bearing potential unless they are using effective contraception Nevirapine should not be initiated in girls with CD4+ T cell count >250 cells/mm3 or in boys with CD4+ T cell count >400 cells/mm 3 because of increased risk of symptomatic hepatic events in these patients. e) Which HAART regimen to use?- NNRTI based or PI based There have been very few direct comparative studies done - and none in children - to determine whether PI or NNRTI based regimen is more effective. 29
There are several factors in determining the optimum choice of regimen as first line therapy and these include effectiveness and durability of the regimen (virologic and immunologic), few adverse effects, tolerability, palatablility with convenient dosing and possessing good future drug options. De Luca et al, 178, Level 6 in a cohort study determined that there was similar efficacy and tolerability for EFV- based compared with LPV/r-based first-line antiretroviral regimens. However, LPV/r was associated with higher rates of hypertriglyceridaemia. MacArthur et al, 179, Level 1 reporting on the FIRST study (RCT of different regimens) in treatment naïve patients, found that clinical endpoints of AIDS defining event, death or CD4 decline to
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Appendix 6 MANAGEMENT OF HIV INFECT
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Appendix 7 MANAGEMENT OF HIV INFECT
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3.30 MB - Academy of Medicine of Malaysia

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