HHS Pediatric Antiretroviral Treatment Guidelines Updated

HHS Pediatric Antiretroviral Treatment Guidelines Updated

The Department of Health and Human Services (HHS) Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV (the Panel) is pleased to announce the release of an updated version of the Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. 

Key updates in this version of the guidelines include the following:

• Preliminary data from an observational surveillance study of birth outcomes among pregnant women on antiretroviral therapy (ART) suggest that there is a possible increased risk of neural tube defects in infants born to women who were receiving dolutegravir at the time of conception. Relevant sections of the Pediatric Guidelines now provide links to information and specific recommendations about the initiation and use of dolutegravir in pregnant women and women of childbearing potential in the Adult and Adolescent Guidelines and the Perinatal Guidelines.
• Boxed Panel recommendations have been added to When to Initiate Therapy in Antiretroviral-Naive Children. The Panel recommends initiating ART in all treatment-naive infants and children with HIV infection and has updated wording to recommend rapid initiation of treatment (within 1-2 weeks) with an expedited discussion of adherence for children aged ≥6 weeks to  < 12 weeks and for children of any age with immunodeficiency or opportunistic illnesses that indicate Stage 3 HIV infection according to the Centers for Disease Control and Prevention. In other situations, sufficient time to fully assess and address issues associated with adherence should be allowed prior to ART initiation.
• The recommendations for which ART regimens to use as initial therapy in children have been revised to reflect the new weight parameters for use of some drugs in children, and there have been changes in recommendations for Preferred vs. Alternativeregimens. See What to Start for a complete list of the revised recommendations.
• Older antiretroviral (ARV) drugs that the Panel does not recommend for use in children because they have unacceptable toxicities, inferior virologic efficacy, high pill burdens, pharmacologic concerns, and/or a limited amount of pediatric data have been removed from the Management of Medication Toxicity or Intolerance tables. Information about these drugs has moved to a new section in Appendix A: Pediatric Antiretroviral Drug Information titled Archived Drugs.
• The Panel now recommends screening all adolescents who are living with HIV for mental health disorders and substance use disorders, and a new subsection was added to Specific Issues in Antiretroviral Therapy for Adolescents Living with HIV about the mental health concerns of adolescents with perinatally acquired HIV.
• Drug sections and Fixed-Dose Combination Tables 1 and 2 in Appendix A: Pediatric Antiretroviral Drug Information were reviewed and updated to include new pediatric data and dosing and safety information, plus new formulations and fixed-dose combinations.

For a complete list of updates, please see What's New in the Guidelines. Additions and revisions are highlighted in yellow throughout the PDF version of the guidelines. 

To view or download the guidelines, go to the Pediatric ARV Guidelines section of AIDSinfo's website. The guideline tables and recommendations can also be downloaded as separate PDF files. 

AIDSinfo Welcomes Your Feedback 

Feedback on the latest revisions to the Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection is welcome. Please send your comments with the subject line "Comments on the Pediatric ARV Guidelines" to ContactUs@aidsinfo.nih.gov by April 30, 2019.