The choice of first-line ART for children follows the same general principles as for adults, but with additional considerations regarding available formulations and certain pharmacokinetic factors. First-line NRTIs generally used for children are 3TC and either AZT or d4T. The third agent is typically an NNRTI, usually NVP. The recommended first- and second-line pediatric ART regimens are summarized in Table 3.2. Once a child weighs more than 10 kilograms, it is possible to administer tablets and capsules, which are cheaper and simpler to procure and store, than syrup formulations. Appendix E presents dosing information for the most commonly available formulations of pediatric ART.

For children co-infected with TB, ART is generally deferred until after at least two months of TB therapy, or (if possible) until TB treatment is completed. Delaying ART avoids adverse drug interactions with rifampin and helps limit the number of medicines a child must take at any one time. In children above three years of age who are receiving rifampin as part of concomitant tuberculosis treatment, the third ART agent should be EFV instead of NVP. The bioequivalence for EFV in children under three years of age has not been determined, however; thus, for HIV/TB co-infected children under three years of age who are receiving R, ABC should be used as the third agent in lieu of EFV. Note that known perinatal exposure to NVP also warrants consideration in determining an appropriate pediatric ART regimen.

^a The bioequivalence for EFV in children under three years of age has not been determined. Thus, for co-infected children under three years of age who are receiving R, ABC should be used as the third agent in lieu of EFV.