title: Antiretroviral therapy for children in resource-limited settings: current regimens and the role of newer agents.
abstract: WHO antiretroviral treatment guidelines for HIV-infected children have influenced the design of treatment programmes in resource-limited settings. This review analyses the latest WHO first- and second-line regimen recommendations. The recommendation to use lopinavir/ritonavir-containing first-line regimens in young children with prior non-nucleoside reverse transcriptase inhibitor (NNRTI) exposure is based on good quality evidence. Recent research suggests that lopinavir/ritonavir-containing first-line regimens should be extended to all young children, irrespective of prior NNRTI exposure. Strategies for overcoming the adverse metabolic effects of rifampicin-containing anti-tuberculosis therapy on antiretroviral therapy regimens have been under-researched in HIV-infected children, creating uncertainty about global recommendations. Preferred second-line recommendations are largely predictable. The exception is that NNRTI-containing second-line regimens are recommended for children previously exposed to NNRTIs and who subsequently did not respond to lopinavir/ritonavir-containing first-line therapy. In these patients, second-line regimens containing newer protease inhibitors (PIs) such as darunavir and tipranavir, or integrase inhibitors such as raltegravir, should be evaluated. Newer antiretroviral agents including second-generation NNRTIs and PIs, C-C chemokine receptor type 5 inhibitors, and integrase inhibitors may assist in further refinement of existing regimen options.
authors: Paediatric Infectious Diseases Unit, Red Cross War Memorial Childrens Hospital, Cape Town, South Africa. Brian.Eley@uct.ac.za
authors: Brian S
authors: BS
authors: Eley
authors: Tammy
authors: T
authors: Meyers
mesh_terms: D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy
chemical_list: D044966:Anti-Retroviral Agents