Table 19Recommendations for the timing of ART following the initiation of TB treatment with a rifampicin-containing regimen in HIV-infected infants and children

Clinical stage of child with TB (as an event indicating need for ART)Timing of ART following initiation of TB treatment (rifampicin-containing regimen) aRecommended ART regimen b
Any CD4 count and any WHO clinical stage of HIV for infants and childrenStart ART soon after TB treatment between 2 and 8 weeks following start of TB treatment.In children <3 years
Preferred first-line regimenTwo NRTIs + NVPb
(Except if <2 years of age and previously exposed to NVP)
or
Triple NRTI first-line regimen(d4T or AZT) + 3TC + ABC
In children ≥3 years:
Preferred first-line regimenTwo NRTIs + EFVc
or
Triple NRTI first-line regimen(d4T or AZT + 3TC + ABC)
In chidren who have been started on a triple NRTI regimen for the purposes of TB/HIV co-treatment, it is preferable to switch to a standard first line regimen on completion of TB treatment
a

Administration of co-trimoxazole prophylaxis is important in children with TB/HIV coinfection.

b

Lead-in dosing should not be used when initiating NVP-containing ART with TB treatment. In addition, the NVP dose should be close to the maximum target dose of 200 mg/m2. Careful clinical monitoring with laboratory support, if available, is recommended where NVP is administered concurrently with rifampicin.

c

EFV is not currently recommended for children <3 years of age, and should not be given to postpubertal adolescent girls who are either in the first trimester of pregnancy or are sexually active and not using adequate contraception.

From: 13, CONSIDERATIONS FOR INFANTS AND CHILDREN WITH TUBERCULOSIS AND HIV

Cover of Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access
Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach: 2010 Revision.
Copyright © 2010, World Health Organization.

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep).

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.