7.5.2 Second-line ART for children (including adolescents)
Consolidated ARV guidelines, June 2013
Recommending potent and effective second-line regimens for infants and children is especially difficult because of the current lack of experience in resource-limited settings and the limited formulations available. This highlights the importance of choosing potent and effective first-line regimens and ensuring their durability and effectiveness by optimizing adherence.
The 2010 WHO guidelines recommended a regimen based on a PI boosted with RTV and combined with two NRTIs as the second-line treatment for children who fail a regimen of two NRTIs plus an NNRTI (105). For infants and young children exposed to an NNRTI as part of PMTCT interventions and starting a PI-based regimen in first-line ART, the recommendation for second-line was to use two new NRTIs and an NNRTI, as this was the only new drug class available.
The recommendations are now better informed by paediatric clinical trial data (156,158, 237) and observational data (157). The Guidelines Development Group also considered operational and programmatic issues including the availability of heat-stable formulations and fixed-dose combinations for children.