When Should Kids With HIV Start Medication?

[NAF]

Effective drugs to treat HIV have significantly improved the prognosis for both adults and children infected with the virus. But a debate lingers over when treatment should begin, especially in children.

Steven Welch, M.D., lead pediatric HIV consultant with Birmingham Heartlands HIV Service in the United Kingdom, believes treatment for children should be deferred. “It remains rational to consider an individual child’s and family’s wishes and circumstances as well as the child’s risk of disease progression in deciding when to start treatment,” Dr. Welch was quoted as saying. He says taking antiretroviral medications too soon risks infecting children with multi-drug-resistant viruses and exposes them to unnecessary cumulative drug toxicities.

Professor Di Gibb, M.D., Ph.D., pediatrician and epidemiologist with Great Ormand Street in London, argues children should start the HIV drugs early. “Deferring treatment initiation for as long as possible is no longer an option,” Dr. Gibb was quoted as saying. She notes several reasons why she believes starting treatments early is even more important in children than in adults, including that children with HIV grow better if they take antiretroviral medication.

Both authors acknowledge there has never been a clinical trial to determine when to start antiretroviral medications in children. They conclude the time has come to have such a trial. SOURCE: PLoS Medicine, published online March 24, 2008