Antiretroviral therapy in children - increased benefit from increased complexity

Cotton, Mark F. (2000-10)

CITATION: Cotton, M.F. 2000. Antiretroviral therapy in children - increased benefit from increased complexity. S Afr Med J, 90(10):985-988.

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Antiretroviral therapy (ART) started as monotherapy with significant short-term gains. With the advent of newer drugs management has become more complex, but with significant gains in quality and quantity of life. The evolution of ART in children lags behind that of adults for many reasons. These include an unwillingness to use new medications in children before efficacy has been established and also difficulty in developing suitable formulations for children. ART has progressed from monotherapy to dual, triple and even quadruple therapy, stimulated by insights into the rapidity of viral replication, development of resistance, and availability of new agents. The most pressing concern with ART is its lack of accessibility to the majority of patients that need it. Other important issues are how and when to use it in ways that promote durability of response but avoid unnecessary use. Most information is derived from studies with relatively short periods of follow-up. The long-term durability of therapy is not known, but with development of new agents should be sustained.

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