Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

Abstract

The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.

The impact of HIV and antiretroviral therapy on TB risk in children: a systematic review and meta-analysis

“…Young children have particularly high TB progression risk, in part due to immature cell-mediated immune responses 1. The impact of age on efficacy of ART is also complex, as early ART initiation, at a better baseline immune status, leads to better immune reconstitution (although adherence can be challenging at the youngest ages due to a paucity of palatable formulations) 83 87 88. The studies in our review were conducted over years when ART treatment guidelines, availability and formulations were evolving.…”

Importance of Self-Motivation and Social Support in Medication Adherence in HIV-Infected Adolescents in the United Kingdom and Ireland: A Multicentre HYPNet Study

“…Although treatment interruption has been shown to have adverse effects in adults, 4 a European pediatric study of CD4 count-driven treatment interruptions of less than 12-month duration did not result in serious adverse clinical outcomes. 16 Despite treatment interruptions not being recommended in global pediatric and adolescent guidelines, 17 adolescents frequently reported taking treatment interruptions. Further research is needed in how best to manage this, particularly in light of a global roll-out of efavirenz-based FDC first line therapy where an unstructured treatment interruption is likely to result in high rates of NNRTI resistance mutations due to the long half-life of efavirenz.…”

Pharmacokinetic Interactions Between Quinine and Lopinavir/Ritonavir in Healthy Thai Adults

“…Globally, lopinavir boosted with ritonavir (LPV/r) remains the most commonly used PI due to its availability as a fixed-dose combination and high genetic barrier to resistance. 14,15 Both quinine and LPV/r are extensively metabolized by the hepatic cytochrome P450 (CYP) 3A4 enzyme. [16][17][18][19][20][21] Elimination halflives of quinine, lopinavir, and ritonavir are in the ranges of 9-15, 6-14, and 3-8 hours, respectively.…”