ART regimens in children are age and weight dependent.
When children grow, doses and regimens have to be changed according to guidelines below.
E.g. a child started at age 2 on ABC+3TC+LPV/r will transition to ABC+3TC+EFV when age >3 and weight >15 kg..
PATIENT CATEGORY |
INDICATION | ARV REGIMEN |
---|---|---|
Adults and adolescents aged 10 years and older (>35 kg) |
Recommended 1st Line Regimen
|
TDF+3TC+EFV1 |
If EFV is contraindicated |
TDF+3TC+ NVP (2014 guidelines) |
|
TDF+3TC+DTG (2016 guidelines) |
||
If TDF is contraindicated |
AZT+ 3TC+ EFV AZT + 3TC + NVP (2014 guidelines) |
|
ABC+3TC+DTG (2016 guidelines) |
||
Pregnant and breastfeeding women |
Recommended 1st Line Regimen
|
TDF+3TC+EFV1 |
If TDF3 and/ or EFV2 contraindicated |
ABC + 3TC + ATV/r | |
Children aged 3 to less than 10 years old or <35kg |
Recommended 1st Line Regimen
|
ABC+3TC+EFV |
If EFV is contraindicated |
ABC + 3TC+NVP (2014 and 2016 guidelines) |
|
Children <3 years of age or <15 kg |
Recommended 1st Line Regimen
|
ABC+3TC+LPV/r Syrup or Pellets4 (2014 and 2016 guidelines) |
. | If unable to use LPV/r |
ABC + 3TC + NVP (2014 and 2016 guidelines) |
Notes
- TDF/3TC/EFV has low toxicity, once daily administration, and is effective against hepatitis B. It is a relatively inexpensive regimen and does not cause
anaemia as AZT (which can then be reserved for second line). EFV has less risk of treatment failure than NVP. - Contraindications for EFV:
- Severe clinical depression or psychosis
- Patient receiving Benzodiazepines or Carbamazepine
- Ongoing complications of neurological disease that block ability to assess side effects of EFV
- Age < 3 yrs or weight < 15 kg
- Contraindications for TDF
- Renal disease and/or GFR < 60
- Adolescents below 35 kg
- Children unable to swallow pellets can start on nevirapine and then be switched to LPV/r when able to swallow
Triple NRTI regimens are now discouraged due to high virological failure rates and decrease of patient’s future ART options
Important drug interactions
- Oral contraceptives: EFV/NVP increase their metabolism causing possible increased risk of contraceptive failure. Use additional barrier method
- Injectable progesteron-only contraceptives and IUDs: there is no significant interaction with ARVs and can be used effectively
- Levonorgestrel implants: effect reduced by EFV and NVP, use additional barrier method
- For emergency contraception: double the dose
- Rifampicin: increase metabolism of PI/nevirapine. See TB-HIV section.