ART in children has been proven to increase survival and decrease HIV-related morbidity and mortality. Children should be started on ART as soon they are diagnosed including those who are presumably diagnosed.
Diagnostic Criteria
There are 2 groups for eligibility to begin treatment:
- All children who have a confirmed diagnosis of HIV, regardless of WHO clinical stage or CD4 cell count
- All HIV exposed children below 18 months old with a presumptive HIV infection.
Table 6.10: When to start ART in children under 15 years
| Age | When you start |
| Children 0-15 years | Treat all of them regardless of WHO clinical stage or CD4 cell count |
| Children below 18 months old who qualify for presumptive diagnosis | Start ART while awaiting for DNA-PCR confirmation test results. |
Table 6.11: First-Line ARV Regimens in Infants and Children under 15 years
| Patient group | Preferred 1L | Justification | Alternatives |
| Children under 3 years | A:ABC/3TC+LPV/r | • Higher genetic resistance barrier
• Avoids NNRTI transmitted resistance from mother during PMTCT • Possibility of malaria prevention • Spares AZT for second line |
A: AZT/3TC+LPV/r
A: AZT/3TC/NVP |
| Children 3 to 15 years | A:ABC/3TC+LPV/r | • Higher genetic resistance barrier
• Avoids NNRTI transmitted resistance from mother during PMTCT • Possibility of malaria prevention • Spares AZT for second line |
A: AZT/3TC+EFV
A: ABC/3TC+EFV A: TDF/3TC/EFV A: AZT/3TC+LPV/r A: AZT/3TC/NVP |
| For TB coinfected children 3 to 15 years already on LPV/r based regimen | A :ABC/3TC+LPV/r | Continue with
ABC/3TC+LPV/R but the dose of LPV/r should be doubled due to the interaction between ritonavir and rifampicin |
|
| For newly initiated TB co-infected children 3 to
15 years |
A: ABC/3TC+EFV
|
ABC/3TC+LPV/R
but the dose of LPV/r should be doubled due to the interaction between ritonavir and rifampicin |
For dosing of ARV regimens see Annex 6, Paediatric Antiretroviral Dosing
NOTE: Children > 2 years with weight above 35kg can use TDF
Special Considerations for LPV/r syrup and tablets
- The LPV/r liquid requires a cold chain only during storage at the facility
- After dispensing, the liquid is stable at room temperature for 1 month so patients should be given a maximum of 1-month supply
- Patients do not have to refrigerate the LPV/r liquid
- LPV/r tablet is heat stable but must be swallowed whole and should not be split or crushed as it loses effectiveness
- LPV/r has shown protection benefit against malaria[1].
[1] Achan J et al. antiretroviral agents and prevention of malaria in HIV infected Ugandan Children. New England Journal of Medicine 2012, 367:2110-2118.