Abstract
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Highlights
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Rationale for initiating combination antiretroviral therapy during the neonatal period Initiation of combination antiretroviral therapy at 6–9 weeks of age has been shown to reduce early infant mortality by 76% and HIV progression by 75% compared with cART deferred until clinical or CD4 criteria were met.[1]
In the landmark Children with HIV Early Antiretroviral Therapy (CHER) trial, the median age of starting cART in the early treatment arm was 7.4 weeks, one-third (10/30) of the overall mortality in the trial occurred in the early treatment arm.[1]
Summary
Affiliations: 1Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Postal address: Red Cross War Memorial Children’s Hospital, Rondebosch 7700, Cape Town, South Africa. The recent shift to targeted HIV polymerase chain reaction (PCR) testing at birth rather than only at 6 weeks of age allows for the earliest detection of neonates in whom intrauterine transmission of HIV infection has occurred and has opened the door to neonatal cART initiation. Availability of validated point-of-care HIV PCR testing will further increase the drive to initiate cART during the early neonatal period. Safety and efficacy data on neonatal cART is currently very limited. Uncertainties relate to pharmacokinetics (PK), dosing, safety and choice of cART regimen. Outline of pharmacokinetics, dosing and safety of antiretrovirals during the neonatal period
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