AEGiS-Glasgow [PL10.2] Formulation, dosing and ART strategies for children with HIV infection

Eighth International Congress on Drug Therapy in HIV Infection

Glasgow, UK - 12-16 November 2006

[PL10.2] FORMULATION, DOSING AND ART STRATEGIES FOR CHILDREN WITH HIV INFECTION

Int Cong Drug Therapy HIV 2006 Nov 12-16;8:Abstract No. PL10.2

Diana Gibb
MRC Clinical Trials Unit, London, UK

PURPOSE OF THE STUDY: Effective prevention of mother-to-child HIV transmission, including testing, perinatal ARV prophylaxis, and safe alternatives to breastfeeding, have resulted in few births of vertically HIV-infected babies in well-resourced countries since 2000. Thus, in Europe and US, paediatric HIV-infected cohorts are older children entering adolescence who have either received previous mono and dual ART prior to HAART, or are newly diagnosed having recently moved to live in these countries. Both groups present challenges in terms of adherence, complex family and psychosocial issues, and for the former group, substantial resistance to ARVs. In contrast, in resource-limited settings, fewer than 10% of pregnant women access prevention. By end-2005, an estimated 2.3 million children were living with HIV infection globally, 2 million in sub-Saharan Africa. Roll-out of ARVs in resource-limited settings has lagged behind adults and has been hampered by the lack of: adequate and timely data on dosing of ARVs across all ages in childhood; appropriate formulations for resource-limited settings, including fixed dose combinations of ARVs; simple dosing tables which can be used by minimally qualified personnel, and the complexities of managing children within families where other family members may have died or are HIV-infected, sick and also require ARVs. Other considerations for HIV-infected children in all settings who require treatment from a much earlier age and for life, frequently starting at a time of immunological immaturity, are strategies to increase efficacy of ART regimens while minimising toxicity and development of resistance. Increased susceptibility to opportunistic and bacterial infections, particularly in young children, and high background prevalence of malnutrition in addition to HIV-related failure to thrive further complicate management. This talk will particularly focus on dosing and formulation issues for infected children from babies to adolescents, as well as discussing long-term ARV management strategies, and where they do and do not differ from approaches in HIV-infected adults.

Plenary Session: Paediatric Infection

2006-11-12
PL10.2

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