Continued...

What are the Antiretroviral drug schedules?


The ideal combination of antiretroviral therapy consists of 3 drugs minimum of which 2 NRTIs form the backbone. The 3 rd drug may either be a protease inhibitor or an NNRTI. Prior to initiation of antiretroviral therapy and on ART, one may need to monitor the child for disease progression (clinically, immunologically and virologically), monitor for potential side effects of antiretroviral therapy and watch for drug resistance.

Table 3 - Recommended Antiretroviral Regimens for Initial Therapy





** There are currently no data on appropriate dosage of EFV in children under age three years.

Except for ZDV chemoprophylaxis administered to HIV -exposed infants during the first 6 weeks of life to prevent perinatal HIV transmission; if an infant is confirmed as HIV-infected while receiving ZDV prophylaxis, therapy should be changed to a combination antiretroviral drug regimen.

Table 4 - Side Effects of Antiretroviral Therapy

NRTI	Hepatitis, fatty liver, Lactic acidosis, pancreatitis, myopathy, peripheral neuropathy, cardiomyopathy, bone marrow suppression.
NNRTI	Rash, Granulocytopenia, Hepatotoxicity
PI	Hyperglycemia, lipodystrophy, hyperlipidemia, osteoporosis, diabetes, increased bleeding tendencies.

Specific side effects




Changing Antiretroviral Therapy

There are certain virologic, immunologic and clinical guidelines to determine whether a child requires a change in the antiretroviral therapy. However, one may consider changing the schedule if there is progression of the disease, failure to thrive (without any cause), progressive neurodevelopment deterioration, or fall in immunologic classification. At least 2 measurements should be performed before considering a change in therapy. Ideally a drug resistance testing should be done to determine what would be the best alternative therapy to be started.

Conclusion

Antiretroviral therapy in children requires special precautions, monitoring for drug interactions, adverse effects of ART and drug resistance. An ideal, individualized rational regime may go a long way in managing an HIV infected child and ensure a normal life style for such a patient.

Last updated on 01-06-2004

How to cite this url