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PENTA 2009 guidelines for the use of antiretroviral therapy in paediatric HIV-1 infection.

Welch, Steven B and Sharland, Mike and Lyall, E G Hermione and Tudor-Williams, Gareth and Niehues, Tim and Wintergerst, Uwe and Bunupuradah, Torsak and Hainaut, Marc and Della Negra, Marinella and Pena, Maria José Mellado and Amador, José Tomas Ramos and Gattinara, Guido Castelli and Compagnucci, Alexandra and Faye, Albert and Giaquinto, Carlo and Gibb, Diana M and Gandhi, Kate and Forcat, Silvia and Buckberry, Karen and Harper, Lynda and Königs, Christoph and Patel, Deepak and Bastiaans, Diane (2009) PENTA 2009 guidelines for the use of antiretroviral therapy in paediatric HIV-1 infection. HIV medicine, 10 (10). pp. 591-613. ISSN 1468-1293. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their Athens login IDs

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Official URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1468-...

Abstract

PENTA Guidelines aim to provide practical recommendations for treating children with HIV infection in Europe. Changes to guidance since 2004 have been informed by new evidence and by expectations of better outcomes following the ongoing success of antiretroviral therapy (ART). Participation in PENTA trials of simplifying treatment is encouraged. The main changes are in the following sections: 'When to start ART': Treatment is recommended for all infants, and at higher CD4 cell counts and percentages in older children, in line with changes to adult guidelines. The number of age bands has been reduced to simplify and harmonize with other paediatric guidelines. Greater emphasis is placed on CD4 cell count in children over 5 years, and guidance is provided where CD4% and CD4 criteria differ. 'What to start with': A three-drug regimen of two nucleoside reverse transcriptase inhibitors (NRTIs) with either a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (PI) remains the first choice combination. Lamivudine and abacavir are the NRTI backbone of choice for most children, based on long-term follow-up in the PENTA 5 trial. Stavudine is no longer recommended. Whether to start with an NNRTI or PI remains unclear, but PENPACT 1 trial results in 2009 may help to inform this. All PIs should be ritonavir boosted. Recommendations on use of resistance testing, therapeutic drug monitoring and HLA testing draw from data in adults and from European paediatric cohort studies. Recently updated US and WHO paediatric guidelines provide more detailed review of the evidence base. Differences between guidelines are highlighted and explained.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their Athens login IDs
Subjects: WC Communicabable diseases
WS Paediatrics. Child health
Divisions: Womens and Childrens > Paediatrics
Related URLs:
Depositing User: Preeti Puligari
Date Deposited: 27 Aug 2014 15:23
Last Modified: 27 Aug 2014 15:23
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/548

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