TABLE 2.

Summary of the Clinical Management Concerns When Treating HIV-Infected Children

Area	Management Issues Requiring Research
Neurocognitive development	Children with HIV accelerate their neurologic development after starting HAART, but they do not catch up with other children
	Neurocognitive development in HIV-exposed but uninfected children is also below normal and needs further study
	The socioeconomic and medical reasons for residual developmental delay in HAART-treated children remains to be delineated
Bone growth	HAART in general, as well as specific antiretroviral agents, has been associated with subnormal bone mineral content
	Children may be especially vulnerable to these effects
	A major confounding factor is the worldwide deficiencies in calcium and vitamin D
Metabolic abnormalities	HAART initiation is associated with decreases in inflammatory cytokines
	Children on HAART nevertheless experience high rates of fat wasting, insulin resistance, dyslipidaemia and hyperlactataemia
	High cholesterol levels may lead to cardiovascular disease, but aggressive lipid management is lacking in children
HIV/TB coinfection	Concurrent HAART improves the response to TB therapy, but TB therapy can have negative effects on HAART effectiveness and toxicity
	Drug-drug interactions and overlapping toxicities pose challenges to concurrent treatment of HIV and TB
	Pharmacokinetic data on the drug-drug interactions are sparse in children
	Data on management of TB and malnutrition, extrapulmonary disease, drug resistance and IRIS in children are very limited
HIV/Malaria coinfection	HIV’s effect on childhood malaria is unclear
	There is only limited paediatric data on PK and toxicity interactions between antiretroviral and antimalarial agents
	Some HAART components may be active against malaria, but this requires further study
Malnutrition	Malnutrition may interfere with absorption of HAART drugs
	Malnourished children have relatively poor outcomes after initiating HAART, but there are no long-term data in this area
	Researchers have not developed optimal antiretroviral/nutritional strategies for malnourished children