ABSTRACT
The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV-1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short-term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long-term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first- and second-line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART 'pipeline' of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.
Subject(s)
Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/drug therapy , Anti-Retroviral Agents/therapeutic use , AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/complications , Adolescent , Child , Child, Preschool , Coinfection/drug therapy , Europe , Female , Humans , Infant , Infant, Newborn , MaleABSTRACT
The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of human immunodeficiency virus (HIV)-positive pregnant women in the UK. The scope includes guidance on the use of antiretroviral therapy (ART) both to prevent HIV mother-to-child transmission (MTCT) and for the welfare of the mother herself, guidance on mode of delivery and recommendations in specific patient populations where other factors need to be taken into consideration,such as coinfection with other agents. The guidelines are aimed at clinical professionals directly involved with, and responsible for, the care of pregnant women with HIV infection.
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , Infectious Disease Transmission, Vertical/prevention & control , Adult , Antiretroviral Therapy, Highly Active , Delivery, Obstetric/methods , Female , HIV-1 , Humans , Pregnancy , Societies, Medical , United KingdomABSTRACT
To prevent the transmission of HIV infection during the postpartum period, the British HIV Association and Children's HIV Association (BHIVA/CHIVA) continue to recommend the complete avoidance of breast feeding for infants born to HIV-infected mothers, regardless of maternal disease status, viral load or treatment.
Subject(s)
Antiretroviral Therapy, Highly Active/adverse effects , Breast Feeding/adverse effects , HIV Infections/transmission , Infectious Disease Transmission, Vertical/prevention & control , Bottle Feeding , Female , Guidelines as Topic , HIV Infections/drug therapy , Humans , Infant, Newborn , Pregnancy , Risk Factors , United KingdomABSTRACT
Antiretrovirals are a significant cost driver for HIV programmes. Current first-line regimens have performed well in real-life programmes, but have a low barrier to virological resistance and still carry toxicity that limits adherence. New drug developments may mean that we have access to safer, more robust and cheaper regimens, but only if the appropriate clinical trials are conducted. We briefly discuss these trials, and demonstrate the large cost savings to the South African HIV programme if these are successful.