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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...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2014
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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. |
format | Online Article Text |
id | pubmed-3868023 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
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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