title: Starting treatment in pediatric HIV infection: try to clarify a gray area.
abstract: The introduction of combination antiretroviral therapy (ART) in HIV-infected children led to a dramatic reduction in HIV-related morbidity and mortality. The decision about which ART regimen to use on children and when to start the treatment needs to focus on assuring normal growth and neuropsychological development. According to the available treatment guidelines, all infants under 1 year of age with HIV should be started on an ART at diagnosis. It is difficult to balance between the benefits of providing treatment to asymptomatic children >1 year and the concerns about long-term resistance and antiretroviral drug side effects if the treatment is started too early. Current guidelines agree that the need for antiretroviral treatment among asymptomatic children >12 months depends on age-specific CD4+ T-cell count thresholds and viral loads. Recent studies showed that the introduction of combination ART during the first year of life preserves a good function of B-cell and T-cell compartments. Starting treatment earlier might have fundamental roles both in preserving the not yet depleted immune function and in preventing the progressive HIV encephalopathy. The comparison of the international guidelines available for starting HIV treatment in children in developed countries highlights a gray area. New randomized controlled studies are needed to clarify the appropriate approach in asymptomatic children between 2 and 5 years of age.
authors.affiliation: From the Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Prato
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Venturini
authors.forename: Elena
authors.initials: E
authors.lastname: Chiappini
authors.forename: Maurizio
authors.initials: M
authors.lastname: de Martino
authors.forename: Luisa
authors.initials: L
authors.lastname: Galli
mesh_terms: D000818:Animals; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D058070:Asymptomatic Diseases; D018791:CD4 Lymphocyte Count; D002648:Child; D019049:Developed Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007223:Infant; D017410:Practice Guidelines as Topic; D019562:Viral Load / Q000502:physiology
chemical_list: D019380:Anti-HIV Agents