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Antiretroviral therapy and medical management guidelines (ATMMGs) of pediatric HIV infection.
Scott G; Oleske J; Grubman S; Mofenson LM; Burr C; Van Dyke R; Dashefsky
December 30, 1998
Int Conf AIDS. 1998;12:609 (abstract no. 32439). Unique Identifier :

ISSUE: To update the 1993 pediatric ATMMGs. PROJECT: In June 1996, a panel of experts in pediatric HIV/AIDS, family members of HIV infected children and government agency representatives met to begin updating the 1993 pediatric ATMMGs. They reviewed published literature, results of adult and pediatric clinical trials, and the consensus of expert opinion. The ATMMGs addressed: initial antiretroviral therapy, choice of agents, consideration for changing antiretroviral therapy, problems in adherence to antiretroviral therapy, treatment of opportunistic infections, standards for neurological and nutritional assessments, palliative care issues, and adverse reactions to the multiple medications used in the treatment of HIV/AIDS. RESULTS: The panel recommended infants and children be initially treated with combination drug therapy which include two nucleoside analogues and a protease inhibitor, and adolescents should be treated according to adult guidelines. Rationale and choices for changes in antiretroviral drugs depended on changes in viral load, immunological deterioration, and clinical disease progression. The choice of new antiretrovirals included all 11 FDA-approved drugs, despite the fact that only seven have pediatric approval. Specific drug therapy, including dosage recommendations, were presented for the most common opportunistic diseases seen in infants, children and adolescents. Difficulty in adherence to multiple drug regimens in treatment of HIV/AIDS was addressed as well as management of adverse drug interactions. Management of neurological complications, nutritional deficiencies, and palliative care were also discussed. LESSONS LEARNED: Infants, children and adolescents should be started and maintained on aggressive combination antiretroviral therapy. Adherence to therapy, management of adverse drug interactions, neurological, nutritional and palliative care are all critical elements in the management of pediatric HIV/AIDS.

MEETING ABSTRACTS CONSENSUS DEVELOPMENT CONFERENCE REVIEW Adolescence Adult Anti-HIV Agents/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS/ *THERAPEUTIC USE AIDS-Related Opportunistic Infections/DRUG THERAPY *Case Management Child Child, Preschool CD4 Lymphocyte Count Dideoxynucleosides/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS/ THERAPEUTIC USE Drug Administration Schedule Drug Approval Drug Therapy, Combination Human HIV Infections/*DRUG THERAPY HIV Protease Inhibitors/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS/ THERAPEUTIC USE Infant Palliative Care Patient Compliance *Practice Guidelines Reverse Transcriptase Inhibitors/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS/THERAPEUTIC USE Viral Load

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