What are the 2020 CDC guidelines for initiation of ART for the treatment of HIV-infected children?

Updated: Jul 26, 2021
  • Author: Elizabeth A Secord, MD; more...
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Antiretroviral treatment (ART) consisting of three drugs from at least two classes should be initiated in all treatment-naive infants and children with HIV infection. Delayed treatment for HIV infection is no longer recommended.

Rapid treatment initiation (within 1-2 weeks of diagnosis) is recommended in all HIV-infected children older than 6 weeks but younger than 12 weeks. This rapid initiation must include a discussion concerning the importance of adherence. Some of these infants will already be on treatment as prophylaxis (initiated as soon after birth as feasible in high risk infants) and alteration of this regimen can be considered.

If ART initiation in a child is not possible for any reason, he or she should be closely monitored virologically (HIV viral load) and immunologically (CD4+ T cells) until treatment is started.

Historically, some older medications had more toxicity and were associated with easier resistance development. Because of this, withholding therapy was once commonly recommended in various age groups and early-stage HIV infection. This is no longer the case, and all children with HIV infection should undergo treatment to avoid disease progression, to avoid infections, to ensure growth and sexual maturation, to avoid neurocognitive consequences of HIV infection, to assist with achieving a normal lifespan, and to eventually avoid further HIV transmission (treatment as prevention).

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