There are > 40 antiretroviral medications, including multidrug combination products, available in the United States, each of which may have adverse effects and drug interactions with other antiretroviral medications or commonly used antibiotics, antiseizure medications, and sedatives. New antiretroviral medications, immunomodulators, and vaccines are under evaluation (1).
Because expert opinions on therapeutic strategies change rapidly, consultation with experts is strongly advised whenever feasible. Tablets containing fixed-dose combinations (FDC) of ≥ 3 medications are now widely used in children and adolescents to simplify regimens (termed single-tablet regimens: 1 tablet once a day) and improve adherence; for very young children, such combinations may not be available in the United States or may be difficult to use.
The standard treatment for children is similar to that for adults: combination antiretroviral therapy (ART) to maximize viral suppression and minimize selection of drug-resistant strains. Preferred regimens vary somewhat by age but typically contain 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) plus 1 integrase strand transfer inhibitor (INSTI) or, rarely, a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (PI) (see table ). Use of antiretroviral medications in treatment-experienced children and adolescents is complex; only commonly selected initial choices (NRTIs, NNRTIs, and INSTIs) for treatment-naive children and adolescents are included in the table.
Regular clinical and laboratory monitoring are important for identifying drug toxicity and therapeutic failure.
For information on antiretroviral medications for children, including dosing, fixed-dose combination products, adverse effects, and drug interactions, see the continually updated Panel on Antiretroviral Therapy and Medical Management of Children Living With HIV's Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection and see Appendix A: Pediatric Antiretroviral Drug Information. See also the Panel's Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV.
Selected Antiretroviral (ARV) Regimens for Initial Therapy of HIV Infection in Children*
Age Group | NRTI Backbone Component (Use 2) | NNRTI or INSTI Component (Use 1) |
|---|---|---|
Infants birth to < 30 days | Zidovudine Zidovudineplus lamivudine (or emtricitabine) (each as oral solution)lamivudine (or emtricitabine) (each as oral solution) | Nevirapine oral solution Nevirapine oral solutionor Weight ≥ 2 kg: Raltegravir granules for oral suspensionWeight ≥ 2 kg: Raltegravir granules for oral suspension |
Children ≥ 30 days to 2 years and weight > 3 kg | Abacavir† (or zidovudine) Abacavir† (or zidovudine)plus lamivudine (or emtricitabine) (each as oral solution)lamivudine (or emtricitabine) (each as oral solution) | Dolutegravir dispersible tabletsDolutegravir dispersible tablets Weight > 6 kg: A fixed-dose tablet of abacavir/lamivudine/dolutegravir is available as a complete once-daily regimen as a dispersible tablet or as a fixed-dose tablet for those > 25 kg. Weight > 6 kg: A fixed-dose tablet of abacavir/lamivudine/dolutegravir is available as a complete once-daily regimen as a dispersible tablet or as a fixed-dose tablet for those > 25 kg. |
Children ≥ 2 years, weight ≥ 14 kg | Emtricitabine Emtricitabineplus tenofovir alafenamidetenofovir alafenamide | Bictegravir A fixed-dose tablet of emtricitabine/tenofovir alafenamide/bictegravir (available in 2 dosing strengths: 1 for children 14 to < 25 kg and 1 for those ≥ 25 kg) is available as a complete once-daily regimen.A fixed-dose tablet of emtricitabine/tenofovir alafenamide/bictegravir (available in 2 dosing strengths: 1 for children 14 to < 25 kg and 1 for those ≥ 25 kg) is available as a complete once-daily regimen. |
Adolescents > 12 years, weight ≥ 25 kg | Emtricitabine Emtricitabineplus tenofovir alafenamidetenofovir alafenamide | Bictegravir A fixed-dose tablet of emtricitabine/tenofovir alafenamide/bictegravir is available as a complete once-daily regimen.A fixed-dose tablet of emtricitabine/tenofovir alafenamide/bictegravir is available as a complete once-daily regimen. |
* Each regimen is designed to contain 2 NRTI antiretroviral (ARV) medications plus either an NNRTI or INSTI component. Several alternative ARV regimens exist; consultation with an expert in pediatric HIV medicine is advised. For information on adverse effects, other regimens and doses (especially for information on fixed-dose combination products), and drug interactions, see the continually updated Panel on Antiretroviral Therapy and Medical Management of Children Living With HIV's Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. Accessed June 19, 2025. | ||
† Abacavir should be used only in children who are HLA-B*5701 negative. | ||
HLA = human leukocyte antigen; INSTI = integrase strand transfer inhibitor; NNRTI = non-nucleoside reverse transcriptase inhibitor; NRTI = nucleoside/nucleotide reverse transcriptase inhibitor. | ||
(See also HIV infection in Infants and Children.)
General reference
1. Weinberg GA, Abuogi L, Siberry GK. Pediatric human immunodeficiency virus infection. In Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, ed. 10, edited by Blaser MJ, Holland S, Cohen JI. Philadelphia, Elsevier, 2025, p. 129.
More Information
The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.
ClinicalInfo.HIV.gov: Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
ClinicalInfo.HIV.gov: Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States
ClinicalInfo.HIV.gov: Maternal HIV Testing and Identification of Perinatal HIV Exposure
ClinicalInfo.HIV.gov: Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV
ClinicalInfo.HIV.gov: Appendix A: Pediatric Antiretroviral Drug Information
Centers for Disease Control and Prevention (CDC): Pre-Exposure Prophylaxis (PrEP)
New York State Department of Health AIDS Institute HIV Clinical Guidelines Program
Perinatal HIV Services Hotline 1-888-448-8765
