7.2.4 First-line ART for children three years and older (including adolescents)
Consolidated ARV guidelines, June 2013
Despite increased access to early infant diagnosis and the widespread availability of several child-friendly fixed-dose combinations, ART coverage among children lags significantly behind that of adults. Treatment recommendations for children should be easy to implement at all levels of the health system, including the primary care level, and by all ART service providers, rather than paediatric specialists alone.
The 2010 WHO ART guidelines for children three years and older (105) recommended starting with an NVP- or EFV-containing regimen combined with an NRTI backbone. The recommended NRTI backbones, in preferential order, were 3TC + AZT or 3TC + ABC or 3TC + d4T. For adolescents with HBV, the preferred backbone was TDF + FTC or 3TC. The new recommendations in the 2013 guidelines are based on new evidence on the preferred NRTIs and NNRTIs to use in this group of children.