Children

There have been a limited number of studies of ART in children. They suggest that many different ARV regimens result in broadly similar improvements in surrogate markers. Most ARVs available for adults are also available for children in specific formulations, including dosages based on either body surface area or weight. First-line treatment options for children include ZDV/3TC plus either a non-nucleoside (NVP or EFZ) or ABC. Children under the age of 3 years should not receive EFZ because of lack of appropriate dosing information. In children over three years, EFZ is the NNRTI of choice when starting ART before completion of rifampicin-containing anti-TB therapy.

Recommended first-line ARV combination regimens for children1

Regimen

Comments

ZDV/3TC2 plus ABC

Preferred if child receiving concomitant anti-TB therapy

° if < 3 years or < 10 kg, NVP ° if >3 years or >10 kg, NVP or EFV

1 Country-specific considerations and preferences should determine which regimen or regimens to make available.

2 The greatest clinical experience is with ZDV/3TC, which is therefore the first choice dual NsRTI regimen. Other dual NsRTI components can be substituted, including ZDV/ddI, d4T/3TC, d4T/ddI, and ddI/3TC. ZDV/d4T should never be used because of proven antagonism.

1 Country-specific considerations and preferences should determine which regimen or regimens to make available.

2 The greatest clinical experience is with ZDV/3TC, which is therefore the first choice dual NsRTI regimen. Other dual NsRTI components can be substituted, including ZDV/ddI, d4T/3TC, d4T/ddI, and ddI/3TC. ZDV/d4T should never be used because of proven antagonism.

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