title: Underdosing of antiretrovirals in UK and Irish children with HIV as an example of problems in prescribing medicines to children, 1997-2005: cohort study.
abstract: OBJECTIVE
  To measure the extent of underdosing of antiretroviral drugs in children.
  
  
  METHODS
  Multicentre cohort study.
  
  
  METHODS
  Clinical centres in hospitals in the United Kingdom and Ireland in the collaborative HIV paediatric study (CHIPS).
  
  
  METHODS
  615 HIV infected children aged 2-12 years receiving antiretrovirals.
  
  
  METHODS
  Doses relative to weight and height compared with current recommended doses in 2004 European guidelines.
  
  
  RESULTS
  The CHIPS cohort of 934 children comprises 80% of diagnosed HIV infected children in the UK and Ireland between January 1997 and March 2005, of which 66% (615) aged 2-12 years were prescribed antiretrovirals. Actual doses standardised to weight or surface area varied widely across individual drugs, antiretroviral class, and calendar time, with children underdosed (prescribed less than 90% of current recommended doses) from 6-62% child time at risk. Three serious issues in prescribing antiretrovirals, which may also be relevant to paediatric prescribing in general, were identified. Firstly, dosing was inadequate before incorrect recommendations at licensing were later revised when important pharmacokinetic results emerged. Secondly, guidelines stating dosage alternatives (by weight/surface area) for the same drug led to different and inconsistent doses. And, thirdly, ongoing growth was not adjusted for.
  
  
  CONCLUSIONS
  Largely inadvertently, HIV infected children in the United Kingdom and Ireland have been underdosed with antiretrovirals, highlighting problems applicable throughout paediatric prescribing.
authors.affiliation: MRC Clinical Trials Unit, London NW1 2DA.
authors.forename: Esse N
authors.initials: EN
authors.lastname: Menson
authors.forename: A Sarah
authors.initials: AS
authors.lastname: Walker
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.forename: Carole
authors.initials: C
authors.lastname: Wells
authors.forename: Gareth
authors.initials: G
authors.lastname: Tudor-Williams
authors.forename: F Andrew I
authors.initials: FA
authors.lastname: Riordan
authors.forename: E G Hermione
authors.initials: EG
authors.lastname: Lyall
authors.forename: Diana M
authors.initials: DM
authors.lastname: Gibb
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D001827:Body Height; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007494:Ireland; D006113:United Kingdom
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents