A Parent’s Guide to HIV Antiretroviral Therapy for Children

If you are familiar with how HIV (human immunodeficiency virus) is managed in adults, know that it is very similar to how HIV is managed in children. It involves antiretroviral therapy (ART), careful monitoring, patient education, preventive care, and support.

Treatment of HIV in children is typically overseen by a medical doctor that specializes in the treatment of infectious diseases in children and adolescents. This provider is called a pediatric infectious disease specialist. These specialists can often be found at medical centers that have HIV programs, and in children’s hospitals with pediatric HIV programs.

Antiretroviral Therapy (ART)

Antiretroviral therapy is the mainstay of treatment for people of all ages who are living with HIV. ART medications cannot cure an HIV infection, but taking ART medications continuously can keep the viral infection suppressed—and keep the immune system strong. Here are a few key points to understand:

• HIV infects and kills white blood cells (which the body needs to fight infections). With time, HIV can reduce the white blood cell count to very low levels, leaving the body unable to fight off infections and certain cancers.
• ART medications disrupt the lifecycle of the virus, so that it cannot replicate. Taken continuously, ART can keep the viral load (the amount of virus in the body) at undetectable levels. This allows the body to maintain normal levels of white blood cells.
• Keeping the virus at undetectable levels also greatly reduces the risk of HIV transmission to others and prevents HIV from progressing into AIDS (acquired immunodeficiency syndrome).
• ART typically involves taking a combination of different ART medications. This is called a regimen. Different ART drugs attack the virus in different ways and work better in combination.
• Many oral medications used to treat HIV combine different ARTs into a single tablet or solution. This helps reduce the number of doses a person has to take each day, which helps improve adherence.
• The choice of ART regimen will take into account multiple factors about the child being treated, including the child’s age, weight, and physical maturity.
• The choice of ART will also depend on factors like potential side effects and the formulations a specific medication is available in—such as pills, chewable tablets, or liquid solutions.
• Because children grow and develop at different rates, body weight is an important factor when deciding on the dosage of ART that a child needs.
• Adherence—taking every dose as scheduled—is critical to successful treatment at all ages. Taking ART inconsistently can cause the virus to become resistant to the drugs in that ART, making HIV more difficult and complicated to treat in the future.
• Your healthcare provider can also help your family plan transition of care—the changes in treatment that will need to be considered as a child with HIV grows into an adolescent and then an adult.

Monitoring and checkups

Both adults and children with HIV will require regular blood tests to monitor viral load and white blood cell counts. These tests are critical to determining if ART is working to suppress the infection.

Regular medical checkups are also essential. This includes physical exams, assessing growth and development, and recommended vaccinations.

Childhood immunizations and HIV

Routine childhood vaccinations play an important role in managing HIV. Because HIV targets the immune system, children living with HIV may be more at risk for infections or more at risk for becoming severely ill from common childhood illnesses.

Your child’s healthcare provider will be your best source of information on recommended vaccines and immunization schedules.

Patient education and support

Apart from treatment, parents and children living with HIV often face other challenges. People of all ages living with HIV encounter stigma and discrimination. This can affect a child’s social development and cause added emotional stress for parents and other family members.

Counselors and other mental health providers can provide strategies and support to cope with challenges like stigma and discrimination—and can benefit all members of a family. Support groups and community organizations offer the chance to connect with other families living with HIV.

One of the biggest challenges that parents of children with HIV encounter is how to talk to their child about the virus. A child who is living with HIV from birth will go through many stages of development while living with the virus—their understanding and education about HIV will need to evolve as they get older.

Good relationships with healthcare providers can be helpful in determining a child’s readiness to learn more, and deciding how and when to talk to a child about different aspects of living with HIV.