August 11, 2011
Developed by the Panel on Antiretroviral Therapy and
Medical Management of HIV-Infected Children
François-Xavier Bagnoud Center, UMDNJ
The Health Resources and Services Administration
The National Institutes of Health
How to Cite the Pediatric Guidelines: Panel on Antiretroviral Therapy andMedical Management of HIV-Infected Children. Guide lines for the Use of Antiretroviral Agents in Pediatric HIV Infection. August 11, 2011; pp 1-268. Available at http://aidsinfo.nih.gov/ContentFiles/PediatricGuidelines.pdf. Accessed (insert date) [include page numbers, table number, etc. if applicable] Use of antiretrovirals in pediatric patients is evolving rapidly. These guidelines are updatedregularly to provide current information.The most recent information is available at http://aidsinfo.nih.gov.
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Whatʼs New in the Pediatric Guidelines?
Key changes made to update the August 16, 2010, Guidelines for the Use of Antiretroviral Agents in Pe diatric HIV Infection are summarized below. All of the changes are highlighted in the guidelines. Throughout thedocument, references have been updated to include new publications where relevant.
When to Start Antiretroviral Therapy Antiretroviral-naive HIV-infected infants 12 months or younger
• Antiretroviral therapy (ART) continues to be recommended for all infants younger than 12 months of age regardless of clinical, immunologic, or virologic symptoms. The Panel believes that although it is important toassess, discuss, and address issues associated with adherence with the infant’s care givers, it is very important to expedite this assessment for young infants given the high risk of dis ease progression and mortality in young HIV-infected infants.
Antiretroviral-naive HIV-infected children 1 year or older
• Current adult ART guidelines are discussed, along with similarities anddifferences between guide lines for children and adults. The CD4 threshold for recommending ART in children ages ≥5 years with minimal or no clinical symptoms has been increased from 25% if age 1 to 500 cells/mm3 if age ≥5 years) and plasma HIV RNA 6 years of age is discussed. • Nevirapine: Extended-release nevirapine is newly available for adults but is not approved for use in children age 1 monthCytomegalovirus disease with onset of symptoms at age >1 month (at a site other than liver, spleen, or lymph nodes) Encephalopathy (at least one of the following progressive findings present for at least 2 months in the absence of a concurrent illness other than HIV infection that could explain the findings): a) failure to attain or loss of develop mental milestones or loss of intellectual ability,verified by standard developmental scale or neuropsychological tests; b) impaired brain growth or acquired microcephaly demonstrated by head circumference measurements or brain atrophy demonstrated by computerized tomography or magnetic resonance imaging (serial imaging is re quired for children 1 month or bronchitis, pneumoni tis, or esophagitis for any duration affecting a child >1 month of ageHistoplasmosis, disseminated (at a site other than or in addition to lungs or cervical or hilar lymph nodes) Kaposi's sarcoma Lymphoma, primary, in brain Lymphoma, small, noncleaved cell (Burkitt's), or immunoblastic or large cell lymphoma of B-cell or unknown im munologic phenotype Mycobacterium tuberculosis, disseminated or extrapulmonary Mycobacterium, other species or unidentified species,disseminated (at a site other than or in addition to lungs, skin, or cervical or hilar lymph nodes) Mycobacterium avium complex or Mycobacterium kansasii, disseminated (at site other than or in addition to lungs, skin, or cervical or hilar lymph nodes) Pneumocystis jiroveci pneumonia Progressive multifocal leukoencephalopathy Salmonella (nontyphoid) septicemia, recurrent Toxoplasmosis of the brain...