Partial non-adherence can explain each of the scenarios listed above and must be addressed before making any medication changes
Antiretroviral therapy should maximally suppress viral replication to undetectable levels using HIV RNA assays and may not always be achievable in HIV-infected children. Perinatally infected children generally have high HIV RNA levels, and clinical benefit may be observed with decrements in HIV RNA levels that do not reach undetectable levels. However, failure to maximally suppress replication may be associated with increased probability of viral mutations and the emergence of drug resistance. The potential for limiting the patient’s future options for potent therapy should be considered when changing regimens and choosing new drugs.
Because HIV RNA levels in infants are high compared with those of infected adults, the initial virologic response of infected infants and young children to initiation of ARV therapy may take longer than in adults. In addition, suppression of HIV RNA to undetectable levels may be achieved less often than has been reported for infected adults despite potent combination therapy. Virologic indications for changing therapy in infected children differ slightly from those recommended for infected adults. Follow adult guidelines for treating infected adolescents.