HIV 3 – Treatment in Children
While significant progress has been made in preventing HIV infections in children,1a HIV remains a significant contributor to under-five deaths in South Africa.2a
All people living with HIV are eligible to start HIV treatment – regardless of age, CD4 cell count, and clinical stage.2b
Do not wait. Any child who tests HIV positive should start HIV treatment, as a matter of urgency.2c
Children react differently to medication than adults. The metabolism, size, and organ function of children play an important role in the development of effective HIV treatments!3a
The majority of children are diagnosed if they show symptoms of disease and the mother is positive.4a
The child of an HIV-infected mother receives HIV antibodies from the mother during pregnancy. These antibodies may persist in his or her blood until 15-18 months of age, even if the child is not infected with HIV. Thus a child may test HIV positive without actually being infected.4a
- HIV exposed: A child is not necessarily assigned an HIV-positive status if the mother is HIV positive. The correct term to use is HIV-exposed.4a,b
Specific tests are done to determine the child’s status, usually at 6 weeks or 3 months after breastfeeding has ceased.4a,c
Counselling is provided for all parents and legal guardians and informed consent must be obtained before any testing is done.4d
Example of the types of medicines that can be prescribed are:2d
Remember: The combinations that are used are called ‘regimens’.2e
A child will usually be started on one of the below regimens, based on age, weight, viral load and other factors as determined by clinical experts:2d,e
Wherever possible it is easier to take combinations of medicines in one formulation – this is called a fixed dose combination. This reduces the amount of different formulations a child has to take.5a
Children may occasionally need to change their HIV regimen, because of intolerance or side effects. Any changes to medicines will be done in consultation with a doctor.4e
How often should a child taking ARVs visit a clinic?
The frequency of visits for children on HIV treatment is as follows:2f
- Children < 6 months should have a clinic visit at least monthly.
- Children 6 to 23 months should have a clinical visit 1-2 monthly, at the doctor’s discretion.
- Children 2 to 5 years should have a clinical visit at least every three months.
- Children > 5 years should have a clinical visit every three months until they are on adult doses.
Up until recently, children’s treatment options often included unpalatable (bad tasting) liquids, some requiring refridgeration. Multiple dosing everyday is difficult for children and parents! Adult caregivers also face barriers like being available to give doses at the right time and dealing with a child that refuses to take the medicine.4g,5a,b Fortunately there have been improvements in formulations over the last several years meaning children have more choice.5b
Early antiretroviral treatment in infants and children has been found to not only improve chances of survival but also ensure normal immune system and neurological (nerves and brain) development.3b
Speak to your doctor or pharmacist for further advice on your condition and the best treatment options for you.
Need more help? Right to Care Paediatric and Adolescent HIV Helpline:
082 352 6642
Medical References
- UNAIDS FACT SHEET. GLOBAL HIV STATISTICS. Available at: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf Last accessed September 2020.
- National Institutes for Allergy and Infectious Diseases (NIAID), National Institutes for Health (NIH). HIV Treatment in Infants and Children. Available from: https://www.niaid.nih.gov/diseases-conditions/hiv-treatment-children Last accessed August 2020.
- National Consolidated Guidelines for the management of HIV in adults, adolescents, children and infants and prevention of mother-to-child transmission. South African National Department of Health, February 2020.
- National Antiretroviral Treatment Guidelines. National Department of Health South Africa, 2004.
- Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. Adherence to Antiretroviral Therapy in children and Adolescents Living with HIV [Last updated April 14, 2020]. Available at: https://aidsinfo.nih.gov/guidelines/html/2/pediatric-arv/83/adherence-to-antiretroviral-therapy-in-children-and-adolescents-living-with-hiv Last accessed September 2020.
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