Early versus deferred antiretroviral therapy in children in low-income and middle-income countries.
OBJECTIVE
We reviewed current literatures on early and deferred initiation of antiretroviral therapy in HIV-infected infants and children in low-income and middle-income countries.


RESULTS
Data from children with HIV antiretroviral (Children with HIV Early Antiretroviral Therapy) study showed a significant reduction of 76% in mortality among infants who received antiretroviral therapy within 3 months of their life as opposed to those on deferred therapy. These data led World Health Organization to promptly revise the guideline to recommend initiation of antiretroviral therapy in all HIV-infected infants regardless of clinical or immunological status. The recommendation for older children is differed between guidelines of developed and developing countries. In general, higher CD4 cell count threshold is used for younger children and similar criteria to those used for adults are used once children are above 5 years of age. The randomized study of when to start antiretroviral therapy in children older than 1 year is ongoing.


CONCLUSIONS
The current trend is to move toward early treatment to reduce morbidity and mortality, achieve immune recovery, normal growth, and development. Even though the antiretroviral rollout program has been successful in Asia and Africa, the challenges lie in diagnosing infants in a timely manner and maintaining infrastructure and resources to support life-long treatment.
Puthanakit
Thanyawee
T
Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. thanyawee@hivnat.org
Bunupuradah
Torsak
T
D000328:Adult; D000349:Africa; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001208:Asia; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011203:Poverty; D017410:Practice Guidelines as Topic
D019380:Anti-HIV Agents