Related Experiment Video
Updated: Jun 23, 2026

Adult and Pediatric Porcine Model of Acute Volume Overload
Published on: January 12, 2024
Children with HIV are not small adults: what is different in pharmacology?
Rafaëlla Lʼhomme1, Adilia Warris, Diana Gibb
1aDepartment of Clinical Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands bNijmegen University Centre for Infectious diseases (NUCI), Nijmegen, The Netherlands cDepartment of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands dMedical Research Council, Clinical Trials Unit, London, UK.
Purpose Of Review:
The pharmacokinetics of antiretroviral drugs are highly variable among HIV-infected children. This review describes pharmacokinetic processes in children and recent pharmacokinetic data in children with HIV. The general lack of pharmacokinetic data and the potential role of therapeutic drug monitoring are discussed.
Recent Findings:
It was found unexpectedly that exposure to lopinavir is decreased in the first 6 months of life. Recent findings of subtherapeutic efavirenz concentrations in children suggest that pediatric dose recommendations should be re-evaluated. In addition, recommended dosing of lamivudine leads to lower exposure in children younger than 6 years of age. Preliminary results of pediatric fixed-dose combination tablets for HIV-infected children with a higher nevirapine to stavudine and lamivudine ratio than adult fixed-dose combinations suggest adequate drug exposure. As an alternative to plasma sampling, concentrations of nevirapine can be determined in saliva.
Summary:
There is a shortage of pharmacokinetic data in the highly variable population of HIV-infected children. Selected pharmacology studies should be undertaken to improve pediatric dose guidance of existing antiretroviral drugs. Therapeutic drug monitoring is a useful tool to optimize treatment in HIV-infected children. More data are needed, however, to establish child-specific reference values.
Related Concept Videos
Pharmacokinetics in Pediatric Patients: Drug Excretion
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
Pharmacokinetics in Pediatric Patients: Drug Distribution
Pharmacokinetics in Pediatric Patients: Drug Metabolism
Drug Dosing: Infants and Children
Factors Affecting Drug Response: Overview
