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close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
Open this folder and view contentsCHAPTER 6: HIV/AIDS AND PREGNANCY
Open this folder and view contentsCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
Open this folder and view contentsCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
Open this folder and view contentsCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
Open this folder and view contentsCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
close this folderCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
View the document13.1 Antiretroviral regimens for HIV infected children
View the document13.2 Goals of Antiretroviral Therapy in children
View the document13.3 Selection of Patients for Antiretroviral Therapy
View the document13.4 Recommended First-Line ARV Regimens in Infants and Children
View the document13.5 Clinical Assessment of Infants and Children Receiving ARV Therapy
Open this folder and view contents13.6 Reasons for Changing ARV Therapy in Infants and Children
View the document13.7 Recommended Second-Line ARV Therapy for Infants and Children
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
Open this folder and view contentsCHAPTER 15: HIV/AIDS AND NUTRITION
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

13.7 Recommended Second-Line ARV Therapy for Infants and Children

Second-line therapy for children in the event of first-line regimen failure would include a change in nucleoside backbone based on the same principles as for adults. Use of protease inhibitors other than LPV/r and NFV is more problematic in children due to lack of suitable pediatric drug formulations for IDV and SQV and lack of appropriate dosing information for ritonavir-boosted PIs other than LPV/r. However, use of SQV/r can be considered as an alternative for children who can swallow capsules and are >25 kg weight and can therefore receive the adult dosage.

The recommended second line regimen for infants and children who have failed their first line is therefore:

Didanosine (ddI)+Abacavir (ABC)+ Ritonavir boosted Lopinavir(LPV/r)

However given the bitter taste of LPV/r, children sometimes refuse it based on taste.

Nelfinavir (NFV) should therefore be considered as the substitute for LPV/r

Antiretroviral Drugs in Paediatric Practice

Drug

Formulation

Dosage

Adverse Events

Comments

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Zidovudine
AZT, ZDV

Suspension 1mg/ml
Capsules 100mg, 250mg
Tablets 300mg

180 mg/m2 bd or
90-180mg/m2 tds
Neonatal dose: 2mg/kg qid

Neutropenia, anemia, headache, myopthy, lactic acidosis (rare)

Can be given with food
Store at room temperature

Lamivudine
3TC

Suspension 10mg/ml
Tablets 150mg

4mg/kg bd
Neonatal dose: 2mg/kg bd

Headache, abdominal pain, fatigue, pancreatitis, peripheral neuropathy, neutropenia,?LFTs, lactic acidosis (rare)

Can be given with food
Store at room temperature

Stavudine
d4T

Suspension 1mg/ml
Capsules 20mg, 30mg, 40mg

1mg/kg bd

Headache, GI upset, rash, peripheral neuropathy,?LFTs, pancretitis, lactic acidosis

Can be given with food
Keep suspension refrigerated

Didanosine
ddI

Suspension 10mg/ml
Tablets 25mg, 50mg, 100mg, 150mg

90-120 mg/m2 bd

Diarrhoea, abdominal pain, nausea, peripheral neuropathy, pancreatitis, lactic acidosis

Give on empty stomach
Keep suspension refrigerated

Abacavir
ABC

Suspension 20mg/ml
Tablets 300mg

8mg/kg bd

Hypersensitivity rash (5%), fever, malaise, musositis, pancreatitis, lactic acidosis

Can be given with food
Store at room temperature
Do not rechallenge after hyper-sensitivity

Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Nevirapine
NVP

Suspension 10mg/ml
Tablets 200mg

Start with 120 mg/m2 once daily for 14 days
Increase to full dose (120-200 mg/m2) every 12 hrs (maximum 200mg every 12 hrs) if no rash or severe adverse events

Rashes, Stevens-Johnson Syndrome,?LFTs, hypersensitivity and hepatitis

Can be given with food
Store at room temperature
Watch for liver toxicity

Efavirenz
EFV

Capsules 50mg, 200mg

Single daily dose
10-15 kg: 200mg
15-20 kg: 250mg
20-25 kg: 300mg
25-32.5 kg: 350mg
>40 kg: 600mg

Rash (mild), somnolence, abnormal dreams, insomnia, confusion, hallucinations, euphoria, amnesia, agitation, abnormal thinking

Can be given with food
Administer at night
Store at room temperature
No pharmacokinetic data <10kg and <3 years of age

Protease Inhibitors (PIs)

Ritonavir
RTV

Suspension 80mg/ml
Capsules 100mg

Initial dose of 250 mg/m2 bd. Increase by 50 mg/m2 bd at 2-3 day intervals to 400 mg/m2 bd
If <2 yrs of age, maximum dose 450 mg/m2 bd

GI intolerance, headache, anorexia, ↑ LFTs, abnormal lipids (rare)

Give with food
Palatability improved by mixing with milk, honey, ice cream, yogurt or chocolate milk shake
Store in refrigerator or room temperature

Nelfinavir
NFV

Suspension 80mg/ml
Tablets 250mg

Paediatric: 55 mg/kg bd. Adolescent: 750mg tds or 1250 mg bd

Diarrhoea, vomiting, rash, abnormal lipids, exacerbation of chronic liver disease (rare)

Administer with food. Suspension may be mixed with water, milk, pudding, ice cream, formula

Lopinavir/ritonavir
LPV/RTV, Kaletra

Suspension 80mg LPV and 20mg RTV per ml
Capsules 133.3 mg LPV and 33.3 mg RTV

230 mg/m2 LPV/57.5 mg/m2 bd RTV bd up to a maximum of 400mg RTV bd
Increase dose with NVP or EFV co-administration

GI intolerance, rash, headache, abnormal lipids, hyperglycaemia, pancreatitis (rare)

Give with food. A high fat meal increases absorption
Refrigerate suspension or keep at room temperature for 2 months

Fixed drug combinations

D4T/3TC/NVP
(Triomune)

Tablet 40mg/50mg/200mg

1 tablet twice daily depending on child’s weight

 

Tablet broken up as per weight of child. Attainment of accurate dosage difficult with breakage of tablet

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