Drug doses must be adjusted as the child grows, or there is a risk of under dosage, development of resistance and sub optimal response; therefore, dosing in children is based on either body surface area or weight. Standardization is important so that non-expert personnel can safely dispense correct doses, and it is therefore desirable to provide health care workers with a table of drug doses that can be administered according to weight bands.
Some ARVs available for adults are also available for children with specific child formulations. However, formulations appropriate for use by young children who cannot swallow whole tablets or capsules are not currently widely available. Many drugs do not have solid formulations in doses appropriate for pediatric use and some solid formulations do not have all drugs components evenly distributed in the tablets (e.g., fixed dose AZT/3TC). Use of tablets that require cutting up, particularly unscored tablets, can result under dosing or overdosing of the drug in the child, which can lead to an increased risk of resistance or toxicity. The national programme shall therefore strive to provide the widest range possible of dosing options for children to mitigate risks of under- and over- dosing.
The preferred first line treatment option for children are:
For children under 3 years old: AZT+3TC+NVP
For children 3 years old or more: AZT+3TC+EFV or NVP d4T is an alternate for AZT in cases of anaemia (Hb<7.5g/dl). It should be noted though that d4T in liquid formulation needs refrigeration, and potential side effects such as peripheral neuropathy are difficult to recognise in children
If a mother has received ARV during pregnancy, either to reduce mother to child HIV transmission (MTCT) or for her own disease, there is a possibility that she may transmit resistant virus to her baby if the baby becomes infected. Additionally, resistance could be induced de novo in the infant if the infected infant is exposed to an antiretroviral drug being used for prophylaxis before the infant infection status is known. This is a particular problem if NVP or 3TC have been used, either alone or as a component of a two-drug regimen, for prophylaxis of MTCT. It is unknown whether ARV choices should be modified for infants who have been exposed to ARVs used for prevention of MTCT. Children who require ARV therapy and who have previously received either single-dose NVP or 3TC as part of prophylaxis for MTCT should be considered eligible for NNRTI-based regimens.