title: Immediate antiretroviral therapy in young HIV-infected children: benefits and risks.
abstract: OBJECTIVE
  Recent WHO guidelines recommend immediate initiation of lifelong antiretroviral therapy (ART) in all children below 5 years, irrespective of immune/clinical status, to improve access to paediatric ART. Interim trial results provide strong evidence for immediate ART during infancy because of high short-term risk of mortality and disease progression, but there is wider debate regarding the potential risks and benefits of immediate ART in asymptomatic children aged above 1 year. Concerns include long-term toxicities and treatment failure, particularly in resource-constrained settings with limited paediatric treatment options.
  
  
  RESULTS
  Benefits of immediate ART among infants appear to be maintained in the mid-term to long-term, with low risk of treatment failure, and better neurodevelopmental outcomes. In contrast, a trial reported no benefits of immediate versus deferred ART in asymptomatic children aged above 1 year. However, observational studies suggest that ART initiation at older ages and lower CD4 reduces the probability of immune reconstitution, with unclear implications on risk of clinical events or treatment change. A recent trial on treatment interruption following early intensive ART suggest that this may be a safe alternative approach.
  
  
  CONCLUSIONS
  Although there are clear benefits of immediate ART among infants, there remains conflicting evidence on the benefits for older children.
authors.affiliation: MRC Clinical Trials Unit at University College London, London, UK.
authors.forename: Intira J
authors.initials: IJ
authors.lastname: Collins
authors.forename: Ali
authors.initials: A
authors.lastname: Judd
authors.forename: Diana M
authors.initials: DM
authors.lastname: Gibb
mesh_terms: D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003072:Cognition Disorders; D004334:Drug Administration Schedule; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007223:Infant; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents