[Antiretroviral therapy in children]. / Antiretrovirale Therapie bei Kindern.

ABSTRACT

Former antiretroviral treatment strategies in pediatric HIV-infection were based on the occurrence of clinical symptoms or loss of CD4-cells. Because of toxicity and dosing concerns HIV-infected children have often been denied new drugs routinely prescribed to HIV-infected adults. Over the last few years new insights into the pathogenesis of HIV disease, the availability of quantitative viral load measurements and the development of new antiretroviral agents have brought dramatic changes in our understanding of the disease and the role of antiretroviral treatment. Similar to adults it was also shown in children that potent combination regimens applied early in the course of HIV-infection can achieve long-term control of viral replication and thus preservation of immune function and reduction of disease progression. However, there are only poor clinical data regarding dosing, pharmacokinetics, and antiretroviral activity of new combination therapies in infants and young children, pediatric studies are urgently needed. Consensus has been growing that children must not be denied modern therapy because of the lack of pediatric clinical data, and recently treatment guidelines were developed by specialists in pediatric HIV-care which recommend early combination antiretroviral therapies in infants and young children. It is likely that recommendations will change as more data become available about the effects of different treatment regimens.