8.01 - Anti-Retroviral Therapy For Children Who Are ARV-Naive 2016

Last updated 6th December 2016


Age of Patient

Preferred

Alternative

Comments

 
≥14 Days to less than 3 years
 
Boosted PI-Based regime*

Zidovudine + Lamivudine + Lopinavir / Ritonavir

* if there is a possible chance of inadequate viral suppression in mother during pregnancy or there is a risk of viral resistance
 


Zidovudine + Lamivudine + Nevirapine
 
Efavirenz best avoided in children < 3 years as limited data available.

Nevirapine preferred in < 3 years old in NNRTI based regime.

Abacavir: Not recommended for children < 3 months; testing for HLA-B*5701 allele to predict HSR before commencing Abacavir. However testing for the HLA-B*5701 allele is not necessary in those given Abacavir and did not have any HSR.

 
≥ 3 years to less than 12 years old
 
Zidovudine + Lamivudine + Efavirenz 



Zidovudine + Lamivudine + Lopinavir / Ritonavir 


Abacavir + Lamivudine + Lopinavir / Ritonavir 
 
Zidovudine + Lamivudine + Twice Daily Darunavir / Ritonavir (Children > 6 Years)

Tenofovir Disoproxil Fumarate + Lamivudine (or Emtricitabine) + Efavirenz

Abacavir + Lamivudine (or Emtricitabine) + Efavirenz


Tenofovir Disoproxil Fumarate: Not approved for neonates / infants < 2 years.



Avoid Lamivudine + Emtricitabine due to high failure rates

 
Children ≥ 12 years

Tenofovir Disoproxil Fumarate + Emtricitabine + Efavirenz

Didanosine + Lamivudine + Efavirenz

Zidovudine + Lamivudine + Once Daily Darunavir / Ritonavir

Zidovudine (or Abacavir) + Lamivudine + Efavirenz


Zidovudine + Lamivudine + Raltegravir

Emtricitabine: Available in Fixed Dose Combination with Tenofovir Disoproxil Fumarate (Truvada). Exacerbation of severe hepatitis B infection if suddenly stopped.


Principles of Therapy

1. Mono therapy or dual therapy is NO LONGER recommended as therapy for HIV infections.
2. Triple drug therapy is the standard treatment to avoid drug resistance and prolong of viral load suppression.
3. Dual NRTI remains the backbone of any regime, combined with another NNRTI or a PI.
4. Lamivudine and Abacavir remain the NRTI backbone of choice for most children based on favorable long-term follow up results.
5. Stavudine is no longer recommended due to its toxicities.
6. All PI should be Ritonavir-boosted (eg. LPV / RV as in Kaletra)
7. It is recommended that the HLA-B*5701 allele be screened before starting Abacavir to predict possible hypersensitivity reactions.
8. Nevirapine is the preferred NNRTI for children < 3 years and Efavirenz or Nevirapine for those > 3 years.