Question 6 - HIV in Infants and Children Question Bank

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HIV in Infants and ChildrenQuestion 6/10

A 10-week-old infant is seen in the clinic to start antiretroviral therapy. Due to unknown maternal HIV status and a precipitous delivery, the mother did not receive any intrapartum antiretroviral medications for the prevention of mother-to-child HIV transmission. In the postpartum period, the infant took a 3-drug antiretroviral postexposure prophylaxis regimen for 6 weeks. An HIV DNA PCR was positive at birth, negative at 2 weeks and 5 weeks (while receiving antiretroviral therapy), but positive at 8 and 9 weeks of age. Additional laboratory studies show an HIV RNA level of 92,305 copies/mL and a CD4 count of 1,034 cells/mm³. The infant weighs 4.9 kg. A baseline HLA B*5701 test is negative.

According to the Pediatric ART Guidelines, which one of the following is considered a preferred initial antiretroviral regimen for this 10-week-old infant?

Tenofovir DF plus emtricitabine plus efavirenz

Tenofovir DF plus emtricitabine plus raltegravir

Abacavir plus lamivudine plus lopinavir-ritonavir

Abacavir plus lamivudine plus dolutegravir

Figure 1. Perferred Antiretroviral Therapy for Infants and Children by Age, Weight, and Drug Class

Source: Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the use of antiretroviral agents in pediatric HIV infection. What to start: regimens recommended for initial therapy of antiretroviral-naive children. April 11, 2023.

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Question Last Updated
September 26th, 2023

Table 1. HHS Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection

Initial Antiretroviral Regimens for Infants from Birth to <30 Days of Age^a,b
Age	Regimens	Age/Weight Restrictions^c
Preferred Initial Regimens Based on Age and Weight at Time of Treatment Initiation
Infants ≥37 weeks of gestation and aged <30 days and Preterm infants with a postmenstrual age of ≥37 weeks at treatment initiation	NNRTI (Nevirapine) or INSTI (Raltegravir) plus two NRTIs
	Nevirapine plus zidovudine plus (lamivudine or emtricitabine)	None
	Ralegravir plus zidovudine plus (lamivudine or emtricitabine)	≥2 kg
Preterm infants ≥32 to <37 weeks of gestation	NNRTI (Nevirapine) plus two NRTIs
	Nevirapine plus zidovudine plus (lamivudine or emtricitabine)	None
Preterm infants <32 weeks of gestation	Consultation with a pediatric HIV expert or the National Perinatal HIV/AIDS Hotline (1-888-448-8765) is recommended
Alternative Initial Regimens Based on Age and Weight at Time of Treatment Initiation
Postmenstrual age ≥42 weeks and Postnatal age of >14 days	PI (Lopinavir-ritonavir) plus two NRTIs
	Lopinavir-ritonavir plus zidovudine plus (lamivudine or emtricitabine)	None
Alternative NRTI Backbone Based on Age and Weight at Time of Treatment Initiation
Infants ≥37 weeks of gestation	Abacavir plus (lamivudine or emtricitabine) if HLA-B*5701 negative^d	None
^aPanel recommendations summarized in this table are for children with HIV-1 infection. ^b Recommendations for antiretroviral drugs or antiretroviral therapy regimens to be used in special circumstances are addressed in the pediatric antiretroviral therapy guidelines (e.g., ARV resistance, HBV coinfection). ^c Fixed dose combinations may be available for some medication combinations. ^d Abacavir is not approved by the U.S. Food and Drug Administration (FDA) for use in full-term neonates and infants aged <3 months. Recent data from the IMPAACT P1106 trial and two observational cohorts provide reassuring data on the safety of ABC in infants when initiated at the age of <3 months. Before abacavir administration, a negative HLA-B*5701 allele test result should be available.

Source:

Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the use of antiretroviral agents in pediatric HIV infection. What to start: regimens recommended for initial therapy of antiretroviral-naive children. June 27, 2024. [HIV.gov]

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HIV in Infants and ChildrenQuestion 6/10

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According to the Pediatric ART Guidelines, which one of the following is considered a preferred initial antiretroviral regimen for this 10-week-old infant?

Initial Antiretroviral Regimens for Infants from Birth to <30 Days of Agea,b

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Initial Antiretroviral Regimens for Infants from Birth to <30 Days of Age^a,b