Paediatric antiretroviral therapy for the general practitioner : main article

The natural history of perinatal HIV infection is somewhat different to that of adults. Children have much higher viral loads. Children's clinical staging follows a modified WHO 3 staging system. Their immunological monitoring is according to CD4 percentage rather than absolute count until about 6 years of age. Children often cannot swallow pills, syrups can be unpalatable and some require refrigeration. Many drugs have not undergone safety testing in young children, therefore options for therapy are limited. Due to high viral loads to start with, children are harder to treat and we sometimes tolerate detectable levels of vireamia if clinical and immunological improvement is sustained. Drug metabolism changes quite rapidly in the first years of life, therefore drug dosing requires careful calculations. Drug dosing goes according to body weight and surface area, and therefore necessitates dose adjustments at almost every visit.