Great Ormond Street Hospital for Children NHS Foundation Trust.
UCL Great Ormond Street Institute of Child Health.
Curr Opin HIV AIDS. 2024 Nov 1;19(6):323-329. doi: 10.1097/COH.0000000000000876. Epub 2024 Jul 5.
Universal antiretroviral (ART) coverage and virological suppression are fundamental to ending AIDS in children by 2030. Availability of new paediatric dolutegravir (DTG)-based ART formulations is a major breakthrough and will undoubtedly help achieve this goal, but treatment challenges still remain.
Paediatric formulations remain limited compared to those for adults, especially for young children, those unable to tolerate DTG or with DTG-based first-line ART failure. Tenofovir alafenamide is virologically superior to standard-of-care backbone drugs in second-line, but paediatric formulations are not widely available. The roles of resistance testing and recycling of backbone drugs following first-line ART failure remain to be determined. Results of trials of novel treatment strategies including dual therapy and long-acting agents are awaited. Although numbers are currently small, safe and effective ART options are urgently required for children developing DTG resistance.
The antiretroviral treatment gap between adults and children persists. The potential benefits from rollout of new paediatric DTG-based fixed-dose combination ART for first-line treatment are considerable. However, children remain disadvantaged when DTG-based first-line ART fails or cannot be used. Research efforts to address this inequity require prioritisation in order to ensure health outcomes are optimised for all ages in all settings.
普及抗逆转录病毒（ART）治疗并实现病毒学抑制，是 2030 年终结儿童艾滋病的关键。新型儿童多替拉韦（DTG）为基础的 ART 配方的出现是一个重大突破，无疑有助于实现这一目标，但治疗挑战依然存在。
与成人配方相比，儿科配方仍然有限，尤其是对于幼儿、不能耐受 DTG 或 DTG 为一线治疗失败的儿童。替诺福韦艾拉酚胺在二线治疗中比标准治疗方案的骨干药物具有更好的病毒学效果，但儿科配方尚未广泛应用。耐药检测和一线治疗失败后骨干药物的再利用作用仍有待确定。新型治疗策略（包括双药治疗和长效制剂）的试验结果尚待观察。尽管目前数量较少，但对于出现 DTG 耐药的儿童，急需安全有效的 ART 选择。
成人和儿童之间的抗逆转录病毒治疗差距仍然存在。在一线治疗中推出新型儿童 DTG 为基础的固定剂量复方 ART 将带来巨大的潜在获益。然而，当 DTG 为基础的一线治疗失败或不能使用时，儿童仍处于不利地位。为了解决这一不平等问题，需要优先开展研究工作，以确保所有年龄段、所有环境中的儿童都能获得最佳的健康结局。
