Beghin Jean-Christophe, Yombi Jean Cyr, Ruelle Jean, Van der Linden Dimitri
a Hôpital Universitaire des Enfants Reine Fabiola , Université Libre de Bruxelles (ULB) , Brussels , Belgium.
b AIDS Reference Laboratory , Université Catholique de Louvain , Brussels , Belgium.
Expert Opin Pharmacother. 2018 Jan;19(1):27-37. doi: 10.1080/14656566.2017.1377181. Epub 2017 Sep 18.
Current international guidelines recommend to treat all HIV-1 infected patients regardless of CD4 cell count. Despite the remarkable worldwide progress for universal access to antiretroviral during the last decade, the pediatric population remains fragile due to lack of randomized studies, inappropriate antiretroviral formulations, adherence difficulties, drug toxicity and development of resistance.
This review summarizes the latest recommendations and advances for the treatment of HIV-infected children and highlights the potential complications of a lifelong antiretroviral treatment initiated early in life.
International guidelines recommend to start combination antiretroviral therapy (cART) as fast as possible in all children diagnosed with HIV-1. The principal goal is to improve survival and reduce mortality as well as rapidly decrease HIV reservoirs. This remains a challenge in resource-limited settings were diagnostic tools and treatment access may be limited. Different new strategies are in the pipeline such as immunotherapy in combination with very early cART initiation to seek remission or functional cure. For the time being and awaiting for long term remission or cure, there is a need for further pharmacokinetics studies, more pediatric formulations with improved palatability and implementation of randomized trials for the newer antiretroviral drugs.
当前国际指南建议对所有HIV-1感染患者进行治疗，无论其CD4细胞计数如何。尽管在过去十年中全球在普及抗逆转录病毒治疗方面取得了显著进展，但由于缺乏随机研究、抗逆转录病毒制剂不合适、依从性困难、药物毒性和耐药性的产生，儿科人群仍然脆弱。
本综述总结了治疗HIV感染儿童的最新建议和进展，并强调了在生命早期开始的终身抗逆转录病毒治疗的潜在并发症。
国际指南建议对所有诊断为HIV-1的儿童尽快开始联合抗逆转录病毒治疗（cART）。主要目标是提高生存率、降低死亡率以及迅速减少HIV储存库。在资源有限的环境中，这仍然是一项挑战，因为诊断工具和治疗途径可能有限。不同的新策略正在筹备中，例如免疫疗法与极早期cART启动相结合以寻求缓解或功能性治愈。目前，在等待长期缓解或治愈的过程中，需要进一步开展药代动力学研究，开发更多口感更好的儿科制剂，并对新型抗逆转录病毒药物进行随机试验。
