Italian guidelines for antiretroviral therapy in children with human immunodeficiency virus-type 1 infection

Human immunodeficiency virus-type 1 (HIV-1) infection and its treatment are peculiar in children. Adherence and compliance must be carefully taken int o account before initiating or changing therapy and in the choice of drugs. Even in the absence of paediatric-specific trial results and notwithstandi ng drug-labelling notations, all antiretroviral drugs should be used when i ndicated. A combined therapy is compulsory. Therapy is highly recommended i n category C or category 3 and recommended in category B children. Indicati ons in categories N1, N2, A1 or A2 are limited. A triple association is rec ommended in category C or category 3 children or in those with a high viral load, when compliance is guaranteed. A step-down strategy is not advisable . Infants' treatment should be inserted into controlled studies. Therapy sh ould be changed when serious side effects or poor tolerance (choose drugs w ith a different toxicity and greater tolerance), poor compliance (individua lize the motives) or treatment failure (evaluate progression and adherence) occurs.