Variable use of therapeutic interventions for children with human immunodeficiency virus type 1 infection in Europe

Although a range of antiretroviral drugs are available for use in children, the appropriate paediatric regimen remains unclear. In a survey to investi gate policies and practices relating to the therapeutic management of child ren infected by the human immunodeficiency virus (HIV), a postal questionna ire was sent to a named paediatrician in 70 major HIV centres in 13 Europea n countries in early 1998. A total of 64 paediatricians (91%) responded. Pn eumocystis carinii pneumonia prophylaxis was found to be routine in all cen tres, although considerable variation existed regarding the rime of startin g and stopping therapy. Prophylaxis for fungal infections and recurrent bac terial infections was common, with cytomegalovirus prophylaxis being less f requent. Although most centres (89%) used all five currently available nucl eoside analogues (ziduvodine, lamivndine, stavudine, didanosine, zalcitabin e), there was considerable: variability regarding the availability of prote ase inhibitors. Most respondents delayed initiation, of antiretroviral ther apy until evidence of disease progression was apparent. The initial prescri ption of 38% of clinicians was triple therapy and that of 57% prescribed do uble therapy, Policies varied regarding the modification to regimens in res ponse to disease progression and emergence of side effects and drug resista nce. Clinical practice was informed by a number of sources, including centr e-specific and national guidelines. Most respondents affirmed the need for European guidelines. Conclusion Approaches to the therapeutic management of pediatric human immu nodeficiency virus infection differ across Europe.