Impact of earlier combination antiretroviral therapy on outcomes in children.
OBJECTIVE
Early initiation of combination antiretroviral therapy (ART) in infants below 12 weeks of age reduces morbidity and mortality. A recent report of transient HIV remission in a child beginning ART from the second day of life has focused attention on very early therapy in the first days of life.


RESULTS
In the randomized children with HIV, early antiretroviral limited ART beginning at a median of 7.4 weeks of age lowered mortality and disease progression significantly compared with deferred ART beginning at a median of 21 weeks on study. In high-burden settings, infants initiating ART appear sicker than in children with HIV early antiretroviral and start at a later age. Many could be diagnosed on the first day of life. There are still programmatic obstacles to early diagnosis and initiation of ART in high-burden settings. There is growing but insufficient information on ART dosages in newborn infants.


CONCLUSIONS
There is now increased focus on initiating ART as postexposure prophylaxis in newborn infants at high risk of vertical transmission in the hope of limiting morbidity and dissemination of the virus.
Division of Paediatric Infectious Diseases, Department of Pediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, Cape Town, South Africa.
Mark F
MF
Cotton
Helena
H
Rabie
D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000494:pharmacology; D016516:CD4-CD8 Ratio; D002675:Child, Preschool; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016896:Treatment Outcome; D019562:Viral Load
D044966:Anti-Retroviral Agents