1. Starting children and infants on ART; what do the guidelines say? Dr Siobhan Crowley Paediatric & Family HIV Care Department of HIV/AIDS World Heath Organization, Email: crowleys@who.int http://www.who.int/hiv/paediatric/en/index.html

2. WHO recommendations Published within adult guidelines in 2003 Stand alone August 2006 Include dosing instructions (Annex E) Review meeting April 2008 http://www.who.int/hiv/paediatric/generictool/en/index.html http://www.who.int/hiv/p ub/guidelines/art/en/ind ex.html

3. April 2008 –Technical Reference group meeting For infants panel reviewed: When to perform virological testing When to start ART What ARVS to start in infants with HIV WHO strongly recommends: all infants under 12 months of age with confirmed HIV infection should be started on ART, irrespective of clinical or immunological stage :

4. What ART to Start in infants – 2008 revision No infant or maternal ARV exposure MTCT ARV Exposure Sd NVP or NNRTI containing ART Non NNRTI exposure Unknown infant maternal MTCT Exposure NVP triple ART PI triple ART # NVP triple ART # If no PI is available use NVP triple ART Mum 34% Baby 18%

5. Children 1 year or over Clinical and/or immunological criteria to start ART Standard first line regimen NNRTI + 2NRTI < 3 years NVP + AZT + 3TC > 3 years EFV + AZT + 3TC Standard second line regimen PI + 2 new NRTI

6. Summary

7. Revised simplified dosing

8. Acknowledgments & resources: HIV Care Technical Reference group Paediatric ARV dosing working group: –Tony Nunn, Ed Caparelli, Shaffiq Essajee, Mark Mirochnick & Diana Clarke Meeting report summarising these recommendations http://www.who.int/hiv/pub/paediatric/WHO_Paediatric_ART_guideline_rev_mreport _2008.pdf http://www.who.int/hiv/pub/paediatric/WHO_Paediatric_ART_guideline_rev_mreport _2008.pdf Proceedings of the meeting http://www.who.int/hiv/pub/meetingreports/art_meeting_april2008/en/index.html 2006 guidelines (being updated to reflect above) http://www.who.int/hiv/pub/guidelines/art/en/index.html Tool to assist in developing dosing recommendations http://www.who.int/hiv/paediatric/generictool/en/index.html A programming guide – how to scale up Paed care and treatment: http://www.who.int/hiv/paediatric/Paeds_programming_framework2008.pdf Paediatric HIV care landing page http://www.who.int/hiv/paediatric/en/index.htmlhttp://www.who.int/hiv/paediatric/en/index.html