7.2.4 First-line ART for children three years and older (including adolescents)

Consolidated ARV guidelines, June 2013

Clinical considerations for scaling up ART for children and key research gaps

Clinical considerations for scaling up ART for children

Section 10.6 (Implementations considerations for key recommendations, Box 10.6) discusses implementation considerations relevant to programme managers. An important consideration for clinicians and other health care providers relates to whether and how regimen changes can be introduced among children who are clinically stable. As children get older, new fixed-dose combinations become available and programmes transition into different first-line regimens. Modifying the ART regimens of clinically stable people can be considered to simplify treatment management and harmonize the ART regimens in use. Table 7.11 summarizes considerations for simplifying and harmonizing ART for children with no history of treatment failure.

Key research gaps

The long-term efficacy and safety of TDF, ABC and EFV and the recommended combination need further investigation. More data are needed on the bone, growth and renal toxicity profiles of TDF in children and adolescents, especially in the context of malnutrition and stunting. Similarly, adverse events associated with EFV during adolescence, such as central nervous system effects, require investigation to ensure safe harmonization with adult treatment regimens. Toxicity surveillance systems implemented alongside ART at sentinel sites can provide data to better understand the frequency and clinical relevance of these toxicities.