Last reviewed, March 2008

Next due for review, March 2009

Anti-HIV treatment is available for babies and children. There is now very good evidence that anti-HIV drugs can work well in babies and children, and there have been big falls in the amount of illness and death caused by HIV in babies and children. Many children who were infected with HIV when they were babies are now in their teens and can look forward to a long and healthy life.

But, just like adults, anti-HIV drugs can cause unpleasant side-effects and need to be taken at the right time and in the right way to work properly.

There are also fewer drugs available for the treatment of HIV in babies and children than in adults.

Monitoring HIV in children and babies

CD4 cells are the immune system cells that HIV attacks. The number of CD4 cells in a sample of blood, or CD4 cell count, gives a rough idea of the health of the immune system.

Before the age of five or six years children have higher CD4 cell counts than adults. This means that babies and children can become ill with HIV when they have CD4 cell counts that would seem high in an adult. Very young children can become ill when their CD4 cell count is between 1000 – 2000.

Because of this doctors use another test to look at the strength of the immune system of babies and young children. This measures the number of CD4 cells as a proportion of all immune system cells. A CD4 cell percentage below 25% shows that there has been some damage to the immune system. A CD4 cell percentage below 15% shows that there’s been a lot of damage and a risk of severe, even life-threatening illness.

Another key test used to monitor HIV is viral load – the amount of HIV in a sample of blood. Babies have very high viral loads – about 200,000 – but this falls gradually over the next five years.

When to start treatment

Decisions are made on an individual basis. It is recommended that a baby or child should take anti-HIV treatment if they are ill because of HIV.

It is also recommended that treatment should be started if there is a risk of HIV-related illness. Babies aged under one year should start anti-HIV treatment if their CD4 cell count is 750 or below, and children aged under five are recommended to do so if their CD4 cell count is 500 or below. Treatment for the over-fives should be considered when their CD4 cell count is around 350.

There’s some evidence that anti-HIV treatment has very good results if it is used before a baby is five months old. This could be because HIV hasn’t yet had a chance to do permanent damage to the immune system.

Anti-HIV drugs

Anti-HIV drugs

There are fewer anti-HIV drugs available for babies and children than adults. And there are restrictions on the use of some of the available drugs according the age or weight or a child.

Drugs available to treat children or babies include:

NRTIs  

3TC, abacavir, d4T, ddI, FTC and the combination pills Combivir and Kivexa.

NNRTIs

Nevirapine and efavirenz.

Protease inhibitors

Atazanavir/ritonavir, fosamprenavir/ritonavir, indinavir, lopinavir/ritonavir, saquinavir/ritonavir and tipranavir/ritonavir.

Fusion and entry inhibitors  

T-20