On April 7, the Department of Health and Human Services released its latest updated treatment guidelines for children and infants with HIV. The Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection were last updated in 2019.

The recent update gives a big nod to Tivicay (dolutegravir) and Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) as preferred regimens for children but doesn’t recommend starting children on Selzentry (maraviroc) due to drug interactions and twice-daily dosing, among other potential drawbacks.

Here are more details:

  • Specifically, the guidelines recommend Tivicay PD, a water-dispersible tablet, for treatment-experienced infants and children at least 4 weeks old, in combination with two nucleoside reverse transcriptase inhibitors (NRTIs). This is a change from the previous guidelines, which limited that treatment to children at least 3 years old. The Food and Drug Administration approved the dispersible tablet for infants in June 2020.
  • Biktarvy is now the preferred regimen for children at least 6 years old and weighing at least 25 kilograms.
  • As a second-line treatment in case Biktarvy or Tivicay PD fail to control HIV, the panel recommends Isentress (raltegravir) in combination with two NRTIs for infants age 4 months or older. Like Selzentry, Isentress in infants must be taken twice a day.
  • As for NRTIs, the guidelines recommend that infants age 1 month or older start on abacavir plus lamivudine (the drugs in the Epzicom combination pill) or abacavir (Ziagen) plus emtricitabine (Emtriva).
  • This bumps zidovudine (AZT, or Retrovir) down to an alternative NRTI for infants age 1 month or older.

Click here to read an announcement about these changes.

Click here to read the full pediatric treatment recommendations.