Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.
Management of Medication Toxicity or Intolerance
Last Updated: April 16, 2019; Last Reviewed: April 14, 2020
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/ Monitoring||Management|
|Nausea/ Vomiting||All ARV drugs, but most notably RTV-boosted PIs||Onset:
||Varies by ARV agent; generally <15%||Unknown||Instruct patient to take PIs with food.
Monitor for weight loss and ARV adherence.
|Reassure patient that these adverse effects generally improve over time (usually in 6–8 weeks).
Consider switching to ARV drugs with smaller tablet sizes (see Appendix A, Table 2).
Provide supportive care.
In extreme or persistent cases, use antiemetics or switch to another ARV regimen.
|Diarrhea||All ARV drugs, but most notably RTV-boosted PIs||Onset:
||Varies by ARV agent; generally <15%||Unknown||Monitor for weight loss and dehydration.||In prolonged or severe cases, exclude infectious or noninfectious (e.g., lactose intolerance) causes of diarrhea.
Reassure patient that this adverse effect generally improves over time (usually in 6–8 weeks). Consider switching to another ARV regimen in persistent and severe cases.
Treatment data in children are lacking; however, the following strategies may be useful when the ARV regimen cannot be changed:
|Pancreatitis||Rare, but may occur with NRTIs or RTV-boosted PIs||Onset:
||<2% in a recent case series||Use of concomitant medications that are associated with pancreatitis (e.g., TMP-SMX, pentamidine, ribavirin)
Advanced HIV infection
Previous episode of pancreatitis
|Measure serum amylase and lipase concentrations if persistent abdominal pain develops.||Discontinue offending agent and avoid reintroduction.
Manage symptoms of acute episodes.
If pancreatitis is associated with hypertriglyceridemia, consider using interventions to lower TG levels.
|Key: ART = antiretroviral therapy; ARV = antiretroviral; FDA = Food and Drug Administration; NRTI = nucleoside reverse transcriptase inhibitor; PI = protease inhibitor; RTV = ritonavir; TG = triglyceride; TMP-SMX = trimethoprim sulfamethoxazole|