Immediate antiretroviral therapy in young HIV-infected children: benefits and risks

Curr Opin HIV AIDS. 2014 Jan;9(1):87-94. doi: 10.1097/COH.0000000000000027.


Purpose of review: Recent WHO guidelines recommend immediate initiation of lifelong antiretroviral therapy (ART) in all children below 5 years, irrespective of immune/clinical status, to improve access to paediatric ART. Interim trial results provide strong evidence for immediate ART during infancy because of high short-term risk of mortality and disease progression, but there is wider debate regarding the potential risks and benefits of immediate ART in asymptomatic children aged above 1 year. Concerns include long-term toxicities and treatment failure, particularly in resource-constrained settings with limited paediatric treatment options.

Recent findings: Benefits of immediate ART among infants appear to be maintained in the mid-term to long-term, with low risk of treatment failure, and better neurodevelopmental outcomes. In contrast, a trial reported no benefits of immediate versus deferred ART in asymptomatic children aged above 1 year. However, observational studies suggest that ART initiation at older ages and lower CD4 reduces the probability of immune reconstitution, with unclear implications on risk of clinical events or treatment change. A recent trial on treatment interruption following early intensive ART suggest that this may be a safe alternative approach.

Summary: Although there are clear benefits of immediate ART among infants, there remains conflicting evidence on the benefits for older children.

Publication types

  • Review

MeSH terms

  • Anti-Retroviral Agents* / administration & dosage
  • Anti-Retroviral Agents* / adverse effects
  • Anti-Retroviral Agents* / therapeutic use
  • CD4 Lymphocyte Count
  • Child
  • Child Development
  • Child, Preschool
  • Cognition Disorders
  • Drug Administration Schedule
  • HIV Infections* / drug therapy
  • HIV Infections* / epidemiology
  • HIV Infections* / mortality
  • Humans
  • Infant
  • Treatment Outcome


  • Anti-Retroviral Agents