What are the significant changes in the 2020 CDC guidelines for treatment regimens in HIV-infected children?

Updated: Jun 23, 2020
  • Author: Elizabeth A Secord, MD; more...
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Answer

The Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection, developed by the HHS Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children, were updated in April 2020. [1]

Significant changes to guidelines

Cobicistat (protease inhibitor [PI] booster) is now approved for pediatric use, and regimens boosted by ritonavir or cobicistat may be used in children. Atazanavir boosted with cobicistat (ATV/c) is now an option for children, as is darunavir boosted with cobicistat (DRV/c).

Updates since the prior (September 2019) version are as follows:

  • Fixed-dose combination (FDC) bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) is now the preferred initial integrase strand transfer inhibitor (INSTI) in children older than 12 years who weigh 25 kg or more and an alternative in children older than 6 years who weigh 25 kg or more.
  • The recommendation for dosing of dolutegravir has been revised to allow use in children who weigh 20 kg or more, although the FDA approval still applies only to children who weigh 30 kg or more.
  • A safety concern about possible neural tube defects in infants whose mothers were receiving dolutegravir was also added to the guidelines and should be considered when prescribing in adolescent girls.

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