Revised pediatric HIV treatment guidelines released

April 2008

Earlier recognition and treatment of HIV in infants and children are key elements in newly revised guidelines issued by the Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children.

Based on new recommendations, HIV infection in children born to women with HIV can be reasonably excluded as early as 1 month of age. Previously, HIV infection could not be reasonably excluded until 4 months of age, which meant that the HIV-infection status of these infants remained uncertain for longer, and Bactrim prophylaxis was routinely required beginning at 6 weeks.

An author of the revised guidelines, George K. Siberry, MD, MPH, medical director of the Harriet Lane Clinic at Johns Hopkins University, told Infectious Diseases in Children, the new guideline may help eliminate unnecessary treatment of patients with Bactrim prophylaxis for prolonged periods.

Although Bactrim is generally well-tolerated in infants, a three times weekly treatment in an infant can become a burden. Additionally, parents may have concerns about bone marrow suppression and allergic reactions that may be associated with treatment.

“From the parents’ perspective, if you can safely avoid Bactrim prophylaxis altogether it is better and the child will not have any risk for side effects,” said Siberry, who is a member of the working group, which is a committee of the Office of AIDS Research Advisory Council.

The revised guidelines also state that negative polymerase chain reaction tests at ages 1 month and 4 months are now sufficient for excluding infants from an HIV diagnosis. Under previous guidelines, definitive exclusion of HIV infection could not be assured until a negative HIV antibody test was performed at 12 to 15 months of age.

New age categories, drugs

Treatment recommendation changes also include reduction from four to three age bands for treatment initiation and changes in immunologic thresholds for when to initiate antiretroviral therapy in children.

The new categories are: younger than 12 months of age, ages 1 year to younger than 5 years, and 5 years and older. The fewer age categories are based on data from large studies demonstrating that CD4 counts (instead of percentages) can be used to predict risks for disease progression and death beginning by about 5 years of age.

Dosing schedules and information on a slew of recently approved HIV treatments approved are also available in the newly- revised guidelines.

For more information:

• To access guidelines on the web visit: www.aidsinfo.nih.gov/contentfiles/pediatricguidelines.pdf.