Antiretroviral Therapy during the Neonatal Period

Abstract

Initiation of combination antiretroviral therapy (cART) at 6–9 weeks of age has been shown to reduce early infant mortality by 76% and HIV progression by 75% compared with cART deferred until clinical or CD4 criteria were met. In the landmark Children with HIV Early Antiretroviral Therapy (CHER) trial, although the median age of starting cART in the early treatment arm was 7.4 weeks, one-third (10/30) of the overall mortality in the trial occurred in the early treatment arm. In another study, 62% of 403 infants who initiated cART at median 8.4 weeks of age already had advanced HIV disease (CD4 < 25% or < 1500 cells/mm³ or World Health Organization [WHO] Stage 3 or 4) at initiation.