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

PURPOSE OF REVIEW: Recent WHO guidelines recommend immediate initiation of lifelong antiretroviral therapy (ART) in all children below 5 years, irrespective of immune/clinical status, to improve access to paediatric ART. Interim trial results provide strong evidence for immediate ART during infancy...

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Detalles Bibliográficos
Autores principales: Collins, Intira J., Judd, Ali, Gibb, Diana M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868023/
https://www.ncbi.nlm.nih.gov/pubmed/24247666
http://dx.doi.org/10.1097/COH.0000000000000027
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author Collins, Intira J.
Judd, Ali
Gibb, Diana M.
author_facet Collins, Intira J.
Judd, Ali
Gibb, Diana M.
author_sort Collins, Intira J.
collection PubMed
description PURPOSE OF REVIEW: Recent WHO guidelines recommend immediate initiation of lifelong antiretroviral therapy (ART) in all children below 5 years, irrespective of immune/clinical status, to improve access to paediatric ART. Interim trial results provide strong evidence for immediate ART during infancy because of high short-term risk of mortality and disease progression, but there is wider debate regarding the potential risks and benefits of immediate ART in asymptomatic children aged above 1 year. Concerns include long-term toxicities and treatment failure, particularly in resource-constrained settings with limited paediatric treatment options. RECENT FINDINGS: Benefits of immediate ART among infants appear to be maintained in the mid-term to long-term, with low risk of treatment failure, and better neurodevelopmental outcomes. In contrast, a trial reported no benefits of immediate versus deferred ART in asymptomatic children aged above 1 year. However, observational studies suggest that ART initiation at older ages and lower CD4 reduces the probability of immune reconstitution, with unclear implications on risk of clinical events or treatment change. A recent trial on treatment interruption following early intensive ART suggest that this may be a safe alternative approach. SUMMARY: Although there are clear benefits of immediate ART among infants, there remains conflicting evidence on the benefits for older children.
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spelling pubmed-38680232013-12-19 Immediate antiretroviral therapy in young HIV-infected children: benefits and risks Collins, Intira J. Judd, Ali Gibb, Diana M. Curr Opin HIV AIDS DOES ANTIRETROVIRAL TREATMENT AT HIGH CD4 COUNTS REDUCE DISEASE RISK FOR HIV-POSITIVE PATIENTS?: Edited by Jason V. Baker and Caroline A. Sabin PURPOSE OF REVIEW: Recent WHO guidelines recommend immediate initiation of lifelong antiretroviral therapy (ART) in all children below 5 years, irrespective of immune/clinical status, to improve access to paediatric ART. Interim trial results provide strong evidence for immediate ART during infancy because of high short-term risk of mortality and disease progression, but there is wider debate regarding the potential risks and benefits of immediate ART in asymptomatic children aged above 1 year. Concerns include long-term toxicities and treatment failure, particularly in resource-constrained settings with limited paediatric treatment options. RECENT FINDINGS: Benefits of immediate ART among infants appear to be maintained in the mid-term to long-term, with low risk of treatment failure, and better neurodevelopmental outcomes. In contrast, a trial reported no benefits of immediate versus deferred ART in asymptomatic children aged above 1 year. However, observational studies suggest that ART initiation at older ages and lower CD4 reduces the probability of immune reconstitution, with unclear implications on risk of clinical events or treatment change. A recent trial on treatment interruption following early intensive ART suggest that this may be a safe alternative approach. SUMMARY: Although there are clear benefits of immediate ART among infants, there remains conflicting evidence on the benefits for older children. Lippincott Williams & Wilkins 2014-01 2013-12-06 /pmc/articles/PMC3868023/ /pubmed/24247666 http://dx.doi.org/10.1097/COH.0000000000000027 Text en © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins http://creativecommons.org/licenses/by-nc-nd/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
spellingShingle DOES ANTIRETROVIRAL TREATMENT AT HIGH CD4 COUNTS REDUCE DISEASE RISK FOR HIV-POSITIVE PATIENTS?: Edited by Jason V. Baker and Caroline A. Sabin
Collins, Intira J.
Judd, Ali
Gibb, Diana M.
Immediate antiretroviral therapy in young HIV-infected children: benefits and risks
title Immediate antiretroviral therapy in young HIV-infected children: benefits and risks
title_full Immediate antiretroviral therapy in young HIV-infected children: benefits and risks
title_fullStr Immediate antiretroviral therapy in young HIV-infected children: benefits and risks
title_full_unstemmed Immediate antiretroviral therapy in young HIV-infected children: benefits and risks
title_short Immediate antiretroviral therapy in young HIV-infected children: benefits and risks
title_sort immediate antiretroviral therapy in young hiv-infected children: benefits and risks
topic DOES ANTIRETROVIRAL TREATMENT AT HIGH CD4 COUNTS REDUCE DISEASE RISK FOR HIV-POSITIVE PATIENTS?: Edited by Jason V. Baker and Caroline A. Sabin
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868023/
https://www.ncbi.nlm.nih.gov/pubmed/24247666
http://dx.doi.org/10.1097/COH.0000000000000027
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