Common combinations used in pediatric patients are shown in Table 1 . Side effects in children are common but do not differ significantly from those in adults. However, since HIV-infected children may already be underweight, GI disturbances such as anorexia, alteration of taste, nausea, vomiting and diarrhea can be especially difficult for parents, children and clinicians to accept. As with adults, protease inhibitors require continuous adherence to the drug regimen. Viral load, immune function, drug tolerance and clinical status guide changes in antiretroviral therapy.
Most clinicians agree that certain signs are indicative of treatment failure.
Conversely, with effective treatment, dramatic response to therapy may occur, including functional improvements, weight gain, shrinking of lymph nodes, spleen and liver. Brain atrophy, as observed on an MRI, may even be reversed, if caught early enough. Because of these clinical impressions, many HIV pediatric specialists believe in treating as early as possible. In addition to antiretroviral therapy, children with HIV infection require surveillance, prevention and treatment of other infections and HIV-associated conditions. PCP prophylaxis is critical for infected children.