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6.5 Antiretroviral Therapy in Children and Adolescents Below 15 Years

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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:

  1. All children who have a confirmed diagnosis of HIV, regardless of WHO clinical stage or CD4 cell count
  2. 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 :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.

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