Most children acquire infection through prenatal exposure. Determination of HIV infection in children below 18 months poses special diagnostic challenges. The pathogenesis of HIV infection and the general virologic and immunologic principles underlying the use of ART are similar for all HIV-infected persons. However, when prescribing ART in children, the following considerations should be made:
Possible in utero exposure to ARV drugs.
Differences in immunologic markers (e.g. CD4+ T-lymphocyte count, viral load. antibody levels) among children of different age groups.
Changes in pharmacokinetic parameters with age caused by the continuing development and maturation of organ systems involved in drug metabolism and clearance.
Differences in the clinical, virologic and immunological parameters between children and adults and among children of different age groups.
Adherence to treatment for children is influenced by parents/guardians.
All antiretroviral drugs approved for treatment of HIV infection may be used for children when indicated. However, for young children requiring syrup or liquid formulations, ART prescriptions may be limited to those available in these formulations. Furthermore, pharmacokinetic parameters in children vary with age and therefore are more complicated than in adults.