Optimizing Antiretroviral Therapy in Children and Adolescents with HIV Infection

HIV infection became a newly recognized disease in the mid 1980s. High morbidity and mortality associated with it prompted the urgent development of new therapeutic agents and combination therapies. Throughout the next 20 years the hopes for cure have risen and fallen, and the vaccine research has failed to reach the evasive target of HIV prevention. It is the development and optimization of antiretroviral therapy (ART) that formed the roadmap for the universal control and prevention of existing and new infections, respectively. As with any new therapeutic modality, the data guiding the dosing, efficacy and safety of antiretroviral (ARV) drugs for children have lagged substantially behind as compared to the information available for adults. An advanced PubMed search for "HIV pharmacokinetics", restricted to age groups of infant, child or adolescent, and all categories of original clinical studies (e.g. excluding reviews and other publication types) resulted in 326 citations. Removing any age restriction increased the number of citations to 1404. While one can argue about the absolute numbers and whether classification is appropriate for all publications in the PubMed database, the ratio is nonetheless significant and not surprising, with over four times as many pharmacokinetic (PK) studies conducted in HIV-infected adults than in children.

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