AntiInfectiveMeds

The same general principles of antiretroviral therapy that apply to HIV-infected adults also apply to HIV-infected pediatric patients; however, the treatment of HIV-infected neonates, children, and adolescents involves unique pharmacologic, virologic, and immunologic considerations. In 1993, the Working Group on Antiretroviral Therapy and Medical Management of HIV-infected Children, a panel convened by the National Pediatric and Family HIV Resource Center (NPHRC), the Health Resources and Services Administration (HRSA), and the National Institutes of Health (NIH) first issued guidelines for the use of antiretroviral agents in the treatment of HIV-infected children. At that time, monotherapy with zidovudine or didanosine was considered an appropriate regimen for initial therapy in HIV-infected pediatric patients.

A review of the agents that the patient already has received is essential. Resistance testing (performed while the patient is still receiving the old regimen) is useful in maximizing the number of active drugs in the new regimen. Viral resistance is an important, but not the only, reason for treatment failure.

The optimal time to initiate antiretroviral therapy in asymptomatic patients is unclear. A decision to initiate antiretroviral therapy in an HIV-infected adult or adolescent who is asymptomatic should be made after considering the patient’s willingness to begin antiretroviral therapy.

Antiretroviral therapy in HIV-infected adults who are treatment naive (have not previously received antiretroviral therapy) should be initiated with a potent multiple-drug regimen. Treatment should be aggressive with the goal of maximal suppression of viral load to undetectable levels.

Lactic acidosis and severe hepatomegaly with steatosis, including fatalities, have been reported in patients receiving NRTIs (abacavir, didanosine, emtricitabine, lamivudine, stavudine, zalcitabine, zidovudine).

The choice of antiretroviral agents to include in the initial regimen used in HIV-infected individuals who are treatment naive (have not previously received antiretroviral therapy) and the most appropriate agents to use in subsequent regimens in previously treated individuals must be individualized based on virologic, immunologic, and clinical characteristics of the individual patient.

Effective management of the disease must be based on updated information related to the biology and pathogenesis of HIV infection, currently available antiretroviral agents, clinical status of the patient.

Antiretroviral agents are synthetic antiviral agents that have antiviral activity against human immunodeficiency virus (HIV) and are used in the management of HIV infection. There currently are 5 different classes of antiretroviral agents commercially available: nucleoside reverse transcriptase inhibitors (NRTIs), HIV protease inhibitors, nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleotide reverse transcriptase inhibitors, and HIV fusion inhibitors.