From the FDA Drug Label
Efavirenz in combination with other antiretroviral agents is indicated for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults and in pediatric patients at least 3 months old and weighing at least 3.5 kg. The recommended dosage of efavirenz for pediatric patients weighing 15 kg is 200 mg once daily for a patient weighing between 7.5 kg and less than 15 kg, but since the patient weighs exactly 15 kg, the dose is 250 mg once daily, which is one 200 mg + one 50 mg capsule. Lamivudine scored tablet is the preferred formulation for HIV-1-infected pediatric patients who weigh at least 14 kg and for whom a solid dosage form is appropriate.
The recommended Antiretroviral Therapy (ART) regimen for a newly diagnosed HIV infected girl weighing 15 kilograms is:
- Efavirenz: 250 mg once daily, which is one 200 mg + one 50 mg capsule 1
- Lamivudine: The dosage for lamivudine is not explicitly stated in the provided drug label for a 15 kg patient, but the label does mention that lamivudine scored tablet is the preferred formulation for HIV-1-infected pediatric patients who weigh at least 14 kg. However, the exact dosage is not provided.
First-line medication options:
- Efavirenz
- Lamivudine (dosage not specified)
Second-line medication options are not explicitly mentioned in the provided drug labels.
Note: The provided information is based on the drug labels for Efavirenz and Lamivudine, and the dosages are subject to change based on the patient's response to treatment and other factors. It's essential to consult a healthcare professional for personalized treatment recommendations. 1 2
From the Research
For a newly diagnosed HIV-positive girl weighing 15kg, the recommended first-line antiretroviral therapy (ART) regimen is a combination of abacavir (ABC), lamivudine (3TC), and dolutegravir (DTG). The specific dosing would be abacavir 300mg once daily, lamivudine 75mg twice daily (or 150mg once daily if using the once-daily formulation), and dolutegravir 20mg once daily, as supported by the most recent and highest quality studies, such as 3 which demonstrated the effectiveness of abacavir/lamivudine with darunavir/ritonavir. This regimen is preferred due to its high genetic barrier to resistance, good tolerability, and effectiveness in viral suppression, as noted in 4. For second-line therapy, if treatment failure occurs, the recommended regimen would be zidovudine (AZT) 180mg twice daily, lamivudine 75mg twice daily, and lopinavir/ritonavir (LPV/r) 200/50mg twice daily. Weight-based dosing is critical in pediatric HIV management to ensure adequate drug levels while minimizing toxicity, as discussed in 5. Regular monitoring of viral load, CD4 count, and potential side effects is essential, as emphasized in 6. Additionally, adherence support and age-appropriate disclosure of HIV status are important components of care, and the child should also receive prophylaxis for opportunistic infections as indicated by her CD4 count and clinical status, as recommended in 7. Key considerations in selecting an ART regimen include the potential for drug interactions, resistance patterns, and the patient's ability to adhere to the regimen, as highlighted in 3 and 4. Overall, the choice of ART regimen should be individualized based on the patient's specific needs and circumstances, with a focus on achieving optimal viral suppression, minimizing toxicity, and promoting long-term adherence, as supported by the evidence from 5, 3, 6, 4, and 7.