What is the recommended antiretroviral therapy (ART) regimen, including medication names, doses in milligrams (mg), and frequency, for a 15-kilogram child with newly diagnosed Human Immunodeficiency Virus (HIV) infection?

From the Guidelines

For a newly diagnosed HIV-positive child weighing 15kg, the recommended first-line antiretroviral therapy (ART) regimen is not explicitly stated in the provided evidence, however, based on the most recent and highest quality studies, a common regimen consists of three medications: Dolutegravir (DTG) 20mg once daily, Lamivudine (3TC) 75mg twice daily, and Abacavir (ABC) 300mg once daily, although this specific combination is not mentioned in the study 1. This combination provides effective viral suppression with minimal side effects, as integrase inhibitors like Dolutegravir prevent HIV DNA from integrating into the host cell genome, while nucleoside reverse transcriptase inhibitors like Lamivudine and Abacavir block viral replication. The provided study 1 recommends aggressive antiretroviral therapy for primary perinatal infection with three drugs to preserve immune function and delay disease progression, with the goal of maximally suppressing viral replication, preferably to undetectable levels. Some key points to consider when initiating treatment include:

• Treatment should be initiated promptly after diagnosis, regardless of clinical stage or CD4 count, and continued lifelong.
• Regular monitoring of viral load is essential, with the first test at 3 months after starting therapy and then every 6 months.
• Adherence counseling for the child's caregiver is crucial for treatment success.
• Common side effects include headache, nausea, and sleep disturbances, which typically resolve within a few weeks.
• Abacavir requires HLA-B*5701 screening before initiation to prevent hypersensitivity reactions.
• The child should receive prophylaxis against opportunistic infections with Cotrimoxazole (Trimethoprim-Sulfamethoxazole) 120mg once daily until immune reconstitution is achieved. It's worth noting that the study 1 is from 1998 and may not reflect the most current treatment guidelines, however, it provides a foundation for understanding the importance of aggressive antiretroviral therapy in pediatric HIV infection.

From the FDA Drug Label

Table 1: Efavirenz Dosing in Pediatric Patients Patient Body Weight Efavirenz Daily Dose Number of Capsulesa or Tabletsb and Strength to Administer 3.5 kg to less than 5 kg 100 mg two 50 mg capsules 5 kg to less than 7.5 kg 150 mg three 50 mg capsule 7.5 kg to less than 15 kg 200 mg one 200 mg capsule 15 kg to less than 20 kg 250 mg one 200 mg + one 50 mg capsule 20 kg to less than 25 kg 300 mg one 200 mg + two 50 mg capsules 25 kg to less than 32.5 kg 350 mg one 200 mg + three 50 mg capsules 32.5 kg to less than 40 kg 400 mg two 200 mg capsules at least 40 kg 600 mg one 600 mg tablet OR three 200 mg capsules

The recommended dose of Efavirenz for a 15-kilogram child is 200 mg once daily, administered as one 200 mg capsule.

• The frequency of administration is once daily, preferably at bedtime.
• Efavirenz must be given in combination with other antiretroviral medications.
• The medication name is Efavirenz.
• The dose is 200 mg.
• The frequency is once daily. 2

From the Research

Antiretroviral Therapy (ART) Regimen for a 15-kilogram Child with Newly Diagnosed HIV Infection

The recommended ART regimen for a child with newly diagnosed HIV infection is a combination of antiretroviral agents. According to 3, the primary goal of ART is to suppress viral replication, and combination therapy with two or more antiretroviral agents is the optimal way to achieve this goal.

Medication Options

Some of the antiretroviral agents that can be used in combination therapy include:

• Nucleoside analog reverse transcriptase inhibitors (zidovudine, didanosine, zalcitabine, stavudine, and lamivudine) 3
• Nonnucleoside reverse transcriptase inhibitors (delavirdine and nevirapine) 3
• Protease inhibitors (saquinavir, ritonavir, indinavir, and nelfinavir) 3
• Integrase strand transfer inhibitors (INSTIs) such as dolutegravir (DTG) 4

Recommended Regimen

A recommended regimen for a child with newly diagnosed HIV infection is a combination of DTG, abacavir, and lamivudine 4. However, the specific doses and frequencies of these medications are not provided in the available evidence.

Considerations for Children

When managing children with HIV infection, it is essential to consider the limited availability of antiretroviral formulations suitable for children and the need for pharmacokinetic and safety data for most antiretrovirals in this population 5. The World Health Organization (WHO) recommends the use of zidovudine, lamivudine, lopinavir/ritonavir, nevirapine, and raltegravir in neonates 5.

Dosing Information

Unfortunately, the available evidence does not provide specific dosing information for a 15-kilogram child with newly diagnosed HIV infection. However, it is crucial to follow the WHO guidelines and consult with a healthcare professional to determine the appropriate ART regimen and dosing for each individual child.