When to initiate Antiretroviral Therapy

Antiretroviral therapy is a double edged sword with very few drugs in the amour of the Pediatric HIV specialist. Drug resistance is a rapidly progressing issue that may create problems in the future therapy options as well in drug regime failure. Antiretroviral therapy also has its own side effects that may add to the morbidity of the disease. Also HIV in children is usually "an acquired familial disease" whereby both parents and often siblings of the patient may also be infected. The cost of the therapy though has reduced over the years is still way beyond reach of most affected individuals and when entire family is affected, whom to start ART first is a very tricky financial and emotional situation.

One must also realize that antiretroviral therapy is not curative but definitely keeps the disease process under control by inhibiting further viral replication. However, mutant viruses are constantly being produced that may cause drug resistance and finally very few therapeutic options.

Compliance of the therapy has to be ensured prior to starting ART for multiple interruptions in the treatment schedule may increase further the chances of drug resistance. One may need to stress to the patients that ART in children presently is recommended as life long therapy. Though there are trials of interrupted HAART (Highly active antiretroviral therapy) schedule in children, there is still a long way before one can determine whether interrupted HAART can be recommended in children.