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Immediate antiretroviral therapy in young HIV-infected children: benefits and risks

Intira J Collins1, Ali Judd, Diana M Gibb

  • 1MRC Clinical Trials Unit at University College London, London, UK.

Current Opinion in HIV and AIDS
|November 20, 2013
PubMed

Insights

Immediate antiretroviral therapy (ART) benefits infants under five, but evidence is mixed for older children. Further research is needed to balance risks and benefits in asymptomatic children.

Area of Science:

  • Pediatric infectious diseases
  • Public health interventions
  • HIV/AIDS management

Background:

  • Recent World Health Organization (WHO) guidelines advocate for immediate lifelong antiretroviral therapy (ART) in children under five to enhance access to pediatric ART.
  • While interim trial results strongly support immediate ART in infancy due to high mortality and disease progression risks, debate continues regarding its benefits and risks in asymptomatic children over one year old.
  • Concerns include potential long-term toxicities and treatment failure, especially in resource-limited settings with limited pediatric treatment options.

Purpose of the Study:

  • To evaluate the benefits and risks of immediate versus deferred antiretroviral therapy (ART) initiation in children under five.
  • To review evidence on the long-term outcomes of immediate ART in infants and asymptomatic older children.
  • To assess the implications of current WHO guidelines in diverse clinical and resource settings.

Main Methods:

  • Review of interim trial results and observational studies on pediatric antiretroviral therapy (ART).
  • Analysis of data regarding mortality, disease progression, neurodevelopmental outcomes, and immune reconstitution.
  • Examination of recent trials on treatment interruption strategies following early intensive ART.

Main Results:

  • Benefits of immediate ART in infants are sustained long-term, showing low treatment failure rates and improved neurodevelopmental outcomes.
  • One trial found no benefit of immediate versus deferred ART in asymptomatic children over one year old.
  • Observational data indicate that initiating ART later or with lower CD4 counts may impair immune reconstitution, with uncertain clinical implications.

Conclusions:

  • Immediate antiretroviral therapy (ART) offers clear advantages for infants.
  • Evidence regarding the benefits of immediate ART for older children remains conflicting.
  • Further research is necessary to clarify optimal ART initiation strategies for different pediatric age groups and clinical statuses.
Abstract

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