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Treatment of Young Children with HIV Infection: Using Evidence to Inform Policymakers

  • Andrew J. Prendergast mail,

    Affiliations: Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, United Kingdom, MRC Clinical Trials Unit, London, United Kingdom, Zvitambo Project, Harare, Zimbabwe

  • Martina Penazzato,

    Affiliation: MRC Clinical Trials Unit, London, United Kingdom

  • Mark Cotton,

    Affiliation: Children's Infectious Disease Clinical Research Unit, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, South Africa

  • Philippa Musoke,

    Affiliation: Mulago Hospital, Paediatric Infectious Diseases Clinic, Kampala, Uganda

  • Veronica Mulenga,

    Affiliation: University Teaching Hospital, Lusaka, Zambia

  • Elaine J. Abrams,

    Affiliation: ICAP, Mailman School of Public Health and College of Physicians & Surgeons, Columbia University, New York, New York, United States of America

  • Diana M. Gibb

    Affiliation: MRC Clinical Trials Unit, London, United Kingdom

  • Published: July 24, 2012
  • DOI: 10.1371/journal.pmed.1001273

Reader Comments (1)

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Also considere the "genetic barrier" to resistance

Posted by Blanche on 26 Jul 2012 at 06:27 GMT

Excellent paper! Congratulations to the authors.
To my point of view, an important point is however missing in Box 2 ("Requirements for ARV drugs in infants and young children"), and not sufficiently develloped in the discussion : The need for drugs with STRONG GENETIC BARRIER TO RESISTANCE. As recalled in the paper, the virological failure remains high in this setting ,incl high resources countries. In addition to short term efficacy consideration, the early loss of ARV activity is a major issue for the future of these children. The phenomenon is well recognized for NNRTI, but it concerns also 3TC/FTC, advised in all guidelines as a first line NRTI choice. Very rapid acquisition of 3TC/FTC resistance after few weeks of viral failure under treatment presently closes the door to ALL fixed dose ARV combination available !
More generally , the first line must be based on ARV combination devoid of quasi immediate risk of resistance. In our experience, a first line based on ZDV-ABC-LPV/r allows not to switch immediately to a second line of ARV in case of early or late failure. Genotype allways remains free of resistance despite several months of residual viral replication. An individually tailored work on compliance with the child and family can be thus implemented without ARV regimen modification , preserving full ARV options for the future.
Stephane Blanche. Paris, France

No competing interests declared.