PENTA 2009 guidelines for the use of antiretroviral therapy in paediatric HIV-1 infection.
PENTA Guidelines aim to provide practical recommendations for treating children with HIV infection in Europe. Changes to guidance since 2004 have been informed by new evidence and by expectations of better outcomes following the ongoing success of antiretroviral therapy (ART). Participation in PENTA trials of simplifying treatment is encouraged. The main changes are in the following sections: 'When to start ART': Treatment is recommended for all infants, and at higher CD4 cell counts and percentages in older children, in line with changes to adult guidelines. The number of age bands has been reduced to simplify and harmonize with other paediatric guidelines. Greater emphasis is placed on CD4 cell count in children over 5 years, and guidance is provided where CD4% and CD4 criteria differ. 'What to start with': A three-drug regimen of two nucleoside reverse transcriptase inhibitors (NRTIs) with either a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (PI) remains the first choice combination. Lamivudine and abacavir are the NRTI backbone of choice for most children, based on long-term follow-up in the PENTA 5 trial. Stavudine is no longer recommended. Whether to start with an NNRTI or PI remains unclear, but PENPACT 1 trial results in 2009 may help to inform this. All PIs should be ritonavir boosted. Recommendations on use of resistance testing, therapeutic drug monitoring and HLA testing draw from data in adults and from European paediatric cohort studies. Recently updated US and WHO paediatric guidelines provide more detailed review of the evidence base. Differences between guidelines are highlighted and explained.
Department of Paediatrics, Heartlands Hospital, Birmingham, UK. steven.welch@heartofengland.nhs.uk
Welch
Steve
S
Sharland
Mike
M
Lyall
E G Hermione
EG
Tudor-Williams
Gareth
G
Niehues
Tim
T
Wintergerst
Uwe
U
Bunupuradah
Torsak
T
Hainaut
Marc
M
Della Negra
Marinella
M
Pena
Maria José Mellado
MJ
Amador
José Tomas Ramos
JT
Gattinara
Guido Castelli
GC
Compagnucci
Alexandra
A
Faye
Albert
A
Giaquinto
Carlo
C
Gibb
Diana M
DM
Gandhi
Kate
K
Forcat
Silvia
S
Buckberry
Karen
K
Harper
Lynda
L
Königs
Christoph
C
Patel
Deepak
D
Bastiaans
Diane
D
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000890:Anti-Infective Agents / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D024882:Drug Resistance, Viral; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000635:transmission; D020276:HIV Long-Term Survivors; D015497:HIV-1; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D010353:Patient Education as Topic; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control; D011247:Pregnancy; D012367:RNA, Viral / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy; D055815:Young Adult
D000890:Anti-Infective Agents; D044966:Anti-Retroviral Agents; D012367:RNA, Viral; D015662:Trimethoprim, Sulfamethoxazole Drug Combination