Newer treatments for HIV in children.
OBJECTIVE
Several new antiretroviral agents have been introduced into pediatric and adult use. This review will summarize information about these new agents and other recent advances in the care of HIV-infected children.


RESULTS
New drugs like tenofovir, emtricitabine, and enfuvirtide are being rapidly introduced into antiretroviral treatments for adult patients. In addition, some well-established drugs are being modified to make them more convenient (specifically didanosine and stavudine). Unfortunately, pediatric data lag for these new agents, in some cases because of complicated pharmacokinetics in children. At the same time, critical information on how to use established drugs like nelfinavir and efavirenz in younger children is slowly becoming available. Although antiretroviral treatment in children has often been initiated at standard doses of milligrams per kilogram, and susceptibility to drug was presumed in individuals without a previous history of exposure, recent data show that some primary infections are caused by drug-resistant virus, and there is a tremendous variability in serum drug levels in children. Researchers and clinicians should consider the role of baseline antiretroviral susceptibility testing and therapeutic drug monitoring to identify the optimal treatment for each child.


CONCLUSIONS
New therapeutic options for children with HIV infection are becoming available as the pharmacokinetics and best strategies for use of newer drugs are studied.
McKinney
Ross E
RE
Departmentof Pedicatrics, Duke University Medical Center, Durham, North Carolina 27710, USA. ross.mckinney@duke.edu
Cunningham
Coleen K
CK
D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016049:Didanosine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000068679:Emtricitabine; D000077560:Enfuvirtide; D015700:HIV Envelope Protein gp41 / Q000627:therapeutic use; D023581:HIV Fusion Inhibitors / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008826:Microbial Sensitivity Tests; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000627:therapeutic use; D010446:Peptide Fragments / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D018119:Stavudine / Q000627:therapeutic use; D000068698:Tenofovir
D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents; D015700:HIV Envelope Protein gp41; D023581:HIV Fusion Inhibitors; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D010446:Peptide Fragments; D018894:Reverse Transcriptase Inhibitors; D003841:Deoxycytidine; D000077560:Enfuvirtide; D000068698:Tenofovir; D018119:Stavudine; D000068679:Emtricitabine; D000225:Adenine; D016049:Didanosine