choice of drugs used to treat your child will depend on a number of factors.
These include the child’s age and weight, and whether the child has any other
illnesses. Clinic staff will consider which combination of drugs might be
easiest for your child to take, to help with adherence (adherence = taking
medicines properly, at the right time, every day). See below for more
information on taking HIV treatment.
a mother has developed a strain of HIV that is resistant to some anti-HIV
drugs, it’s possible that this resistance may have been passed onto her child. Your
child should have a resistance test when decisions are being made about the
most suitable combination of drugs for him or her.
test (HLA B*5701) should also be performed to check for the possible severe
hypersensitivity reaction to the drug abacavir (Ziagen, also in the combined pills Kivexa and Trizivir). If
the HLA B*5701 test is positive then your child should not receive abacavir. See Side-effects for more information on
are different types, or classes, of anti-HIV drugs. These work against HIV in
different ways. To ensure that HIV treatment is successful at suppressing the
virus, it is usual to take a combination of three anti-HIV drugs and these will
come from at least two different classes of drugs. You can find out more about
the classes of anti-HIV drugs, and about the drugs in each class, in NAM’s
booklet Anti-HIV drugs, or by using My drugs chart, an online tool to create
a personalised drug chart.
preferred first-line combination for children comprises two drugs from the nucleoside
reverse transcriptase inhibitor class (NRTIs) – often called the “backbone” –
plus either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a
protease inhibitor (PI), two other classes of anti-HIV drug – often called the “third
12s: Abacavir and lamivudine are the most likely recommended combination of
NRTIs (backbone drugs) for children under twelve years of age. If your child is
HLA B*5701 test positive, then zidovudine and lamivudine or tenofovir and
emtricitabine may be recommended.
years and over: Either abacavir and lamivudine or tenofovir and emtricitabine are
recommended and may be offered in combined tablets: as Kivexa (abacavir/lamivudine), or Truvada (tenofovir/emtricitabine).
NNRTIs and PIs
NRTI drugs are combined with either an NNRTI or a PI. If an NNRTI is chosen, for
children aged under three, the preferred NNRTI is nevirapine (Viramune). For children aged over three,
the preferred NNRTI is efavirenz (Sustiva).
inhibitors usually have their anti-HIV effect boosted by taking them with a
small dose of a second protease inhibitor called ritonavir. If a PI is chosen:
6 years: The boosted protease inhibitor, Kaletra
(lopinavir/ritonavir) is the most likely drug to be chosen.
years: atazanavir (Reyataz)/ritonavir
is the most likely drug to be chosen.
years and over: atazanavir (Reyataz)/ritonavir
or darunavir (Prezista)/ritonavir may
Kaletra is the only
formulation which has both the PI and the ritonavir “booster” combined in the
same tablet or liquid; for all the others the booster must be taken separately.
certain circumstances, an integrase inhibitor – either raltegravir (Isentress) or dolutegravir (Tivicay) – may be offered for children
aged 12 and over.
your child is starting treatment during adolescence (12 years and over) it is
often recommended that treatment starts with a boosted protease inhibitor. When
viral load is well controlled your child can switch to NNRTI-based treatment.
This is intended to reduce the risk of drug resistance if there are early
problems with taking medication (HIV is less likely to become resistant to PIs