Antiretroviral therapy in HIV-infected infants and children.

Antiretroviral (ARV) therapy in human immunodeficiency virus(HIV)-infected infants and children has changed dramatically over the past several years, from monotherapy in the 1990s to the current use of combination regimens, including highly active ARV therapy (HAART). HAART has been associated with increased survival, reduction in opportunistic infections, improved growth and neurocognitive function, and improved quality of life. The goal of HAART is to achieve maximal suppression of viral replication to prevent disease progression, preserve immunologic function, and reduce the development of resistance while minimizing therapy-related side effects. A total of 16 ARV drugs have an approved pediatric treatment indication and are available as a pediatric formulation, tablet, or capsule size as of February 2009 (Table 1). ARV treatment options are continually being updated because of availability of new medications, formulations, and dosing recommendations. Although this review summarizes the current information, US readers should refer to the Working Group Guidelines on Antiretroviral Therapy and Medical Management of HIV-Infected Children for details, including the evidence basis for the treatment recommendations and future updates. International readers should refer to the World Health Organization and Pediatric European Network for Treatment of acquired immunodeficiency syndrome guidelines as well as locally applicable national and regional guidelines.