What are the CDC recommended initial ART regimens for the treatment of HIV-infected infants and children?

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

Answer

Preferred initial therapy in treatment-naïve infants and children consists of a two–nucleoside reverse transcriptase inhibitor (NRTI) backbone plus an INSTI or nonnucleoside reverse transcriptase inhibitor (NNRTI) or PI (boosted).

NRTI backbone options include the following:

  • Birth to younger than 3 months: ZDV plus 3TC or emtricitabine (FTC)
  • Children aged 3 months to younger than 6 years: ZDV plus 3TC or FTC OR abacavir (ABC) (with pre-testing to ensure HLAB*5701-negative status) plus 3TC or FTC
  • Children 6 years or older: ABC plus 3TC or FTC

Although ZDV is not a preferred ART agent in children older than 6 years, it may be continued rather than changed to another ART agent if it is effectively suppressing the viral load. It is also an alternative choice for initial therapy.

NNRTI options include the following:

  • Children older than 14 days to age 3 years: NVP
  • Children aged 3 years or older: NVP preferred, alternatively efavirenz (EFV)

PI options include the following:

  • Children younger than 14 days to age 3 years: LPV/r
  • Children older than 3 years and less than 25 kg: Atazanavir plus ritonavir (ATV/r) or darunavir/r (DRV/r-twice daily)
  • Cobicistat (PI booster) is now approved for pediatric use, and regimens boosted by ritonavir or cobicistat may be used as an alternative to ritonavir boosting in children. Atazanavir boosted with cobicistat (ATV/c) is now an alternative for children, as is darunavir boosted with cobicistat (DRV/c).

INSTI options include the following:

  • Children aged 14 days to 3 years (≥2 kg): Raltegravir (RAL) (oral suspension or chewable)
  • Children aged 3 years or older (< 25 kg): RAL
  • Children aged 3 years or older (≥25 kg): Elvitegravir/cobicistat (EVG/c)
  • Children aged 3 years or older (≥25 kg): Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (EVG/c/FTC/TAF) is a fixed-dose combination option.
  • Children aged 6 years or older (≥30 kg): Dolutegravir
  • Children aged 12 years or older (≥25 kg): Bictegravir (BIC) in fixed dose combination (FDC)
  • Fixed-dose combination (FDC) bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) is now the preferred initial 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.

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