7.2.3 First-line ART for children younger than three years of age
Consolidated ARV guidelines, June 2013
- A LPV/r-based regimen should be used as first-line ART for all children infected with HIV younger than three years (36 months) of age, regardless of NNRTI exposure. If LPV/r is not feasible, treatment should be initiated with a NVP-based regimen (strong recommendation, moderate-quality evidence).
- Where viral load monitoring is available, consideration can be given to substituting LPV/r with an NNRTI after virological suppression is sustained (conditional recommendation, low-quality evidence).
Special note: The randomized control trial supporting the use of this approach (148,161) defined virological suppression as a viral load ≤400 copies/mm3, with the goal of identifying the children who are more likely to be able to safely substitute LPV/r with NVP. The use of a higher viral load cut-off for determining virological suppression has not been studied in the context of this strategy.
- For infants and children infected with HIV younger than three years, ABC + 3TC + AZT is recommended as an option for children who develop TB while on an ART regimen containing NVP or LPV/r. Once TB therapy has been completed, this regimen should be stopped and the initial regimen should be restarted (strong recommendation, moderate-quality evidence).
- For infants and children infected with HIV younger than three years, the NRTI backbone for an ART regimen should be ABC or AZT + 3TC (strong recommendation, low-quality evidence).