ANTIRETROVIRAL THERAPY FOR INFECTION DUE TO HUMAN-IMMUNODEFICIENCY-VIRUS IN CHILDREN

Considerable progress has been made in developing treatment strategies that have improved the quality and duration of life of infants and ch ildren with symptomatic infection due to human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). To optimize these advances, antiretroviral therapy must be coupled with comprehensive, m ultidisciplinary supportive care and psychosocial support. It is also important to note that HIV infection in children differs from that in adults in terms of clinical presentation and rate of disease progressi on. The period of clinical latency is shorter, and disease progression can be accelerated in some infants and children.1-3 These characteris tics of HIV disease in children provide measurable clinical end points that can be used to monitor progression of the disease and response t o antiretroviral therapy. For example, the devastating impact of HIV i nfection on the linear growth, weight gain, and neurocognitive develop ment of infants and children provides disease-specific measures for as sessment of the activity and efficacy of antiretroviral agents. Simila rly, the potential for immune recovery may be greater in young childre n; thus the magnitude of immune response to therapeutic interventions may be greater than that in HIV-infected adults. Drugs need to be admi nistered to infants and children according to body weight or surface a rea, making careful pharmacokinetic monitoring necessary and permittin g clinical-pharmacological correlations that can help validate the act ivity or toxicity of new antiretroviral agents.4-9 In this commentary we will review the current status of antiretroviral treatment of HIV-i nfected children and convey the current clinical standard of practice as well as areas of ongoing investigation, uncertainty, or controversy .