7.2.3 First-line ART for children younger than three years of age

Consolidated ARV guidelines, June 2013

Clinical considerations and key research gaps

Clinical considerations

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 the challenges of providing LPV/r for young children. When clinicians anticipate significant difficulties in dealing with storing or administering LPV/r, using NVP (especially an NVP-based fixed-dose combination) can be considered. In addition, using LPV/r oral liquid should be avoided in premature babies or in fullterm babies younger than 14 days (167). Dosing for children younger than six weeks should be calculated based on body surface area (Annex 3).

Key research gaps

The extent to which new approaches to PMTCT influence the resistance pattern of children becoming infected with HIV despite exposure to ARV drugs for PMTCT still needs to be fully explored outside trial settings. In addition, more evidence is needed to inform the optimal choice of NRTIs and to confirm the safety of EFV-containing regimens, as a first-line option or within PI-sparing strategies in the absence of viral load or genotyping. Studies to fully address the long-term metabolic implications of using LPV/r-based regimens for infants and young children are also needed.