Updated guidelines for the treatment of HIV in children for the USA and Russia

Earlier this month the US Department of Health and Human Services published their updated guidelines for the treatment of HIV infection in children and infants. The changes include the recommended treatment regimens, as well as clinical and laboratory monitoring. In January 2021, the Russian Ministry of Health also approved a set of updated clinical guidelines for HIV treatment in children and adults. This article provides a brief overview of the updated guidelines from both countries.

Monitoring

The American guidelines, for the first time, include guidance on the use of telemedicine and communications which monitoring children starting or switching antiretroviral therapy (ART). Experts point out that using telemedicine to provide remote access to HIV care services can provide the same results as in-person visits when done properly. Thus, it is possible to provide continuous monitoring to assess the effectiveness, tolerability and adverse events, as well as helping to improve adherence. Additional check-ins via telephone and/or telemedicine are especially important when caring for adolescent patients, notes the guidelines.

The new Russian guidelines do not touch on this topic.

Treatment

Both the Russian and American guidelines are similar in their choices of starting antiretroviral therapy for children who are treatment naïve (have not yet started treatment). In both cases, three drugs are recommended for starting therapy – a combination of two nucleoside / nucleotide reverse transcriptase inhibitors and either a protease inhibitor, non-nucleoside reverse transcriptase inhibitor, or an integrase inhibitor.

When it comes to dolutegravir (DTG) based guidelines the Russian 2021 guidelines allow prescribing for children aged 12 years and up. The US guidelines, however, suggest a DTG + 2 NRTI regimen, available as a dissolving tablet, for infants and young children as early as four weeks and weighing at least 3KG.

The efficacy and suitability of DTG, recommended by the World Health Organisation (WHO), has been supplemented over time by new research findings. At the last Conference of Retroviruses and Opportunistic Infections (CROI 2021) the results of a study conducted amongst children and adolescents weighing more than 14KG were presented, they showed that DTG-based regimens were as effective as standard treatment and less likely to result in regime modification due to side effects.

American experts also recommend the use of raltegravir (RAL) + 2 NRTIs as an alternative, rather than preferred, regimen due to its twice daily dosage requirement and a lower barrier to resistance compared to DTG. In Russia, RAL is on the list of preferred regimens for children from 2 to 12 years old.

You can read the American ‘Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection’ here: https://clinicalinfo.hiv.gov/en/guidelines/pediatric-arv/whats-new-guidelines?view=full

You can read the Russian ‘Clinical guidelines- HIV infection in children’ here: http://cr.rosminzdrav.ru/schema/459