Pediatric clinical pharmacology and its implications for antiretroviral drug development

Purpose of review Highly active antiretroviral therapy, which is widely available throughout developed countries, has become increasingly effective for treating the human immunodeficiency virus. In contrast, access to antiretroviral therapy in low-income countries is difficult at best. Thus, antiretroviral therapy for pediatric patients in resource-rich countries predominantly targets new drugs, and in low-income countries focuses on acquiring inexpensive, generic antiretroviral compounds available in pediatric-friendly formulations. Regardless of the economic region, success of antiretroviral therapy in pediatric patients depends upon our understanding of the physiological differences in drug absorption and disposition that occur with age, and our ability to adjust antiretroviral dosing according to these changes. The purpose of this review is to describe these differences and present recently published pharmacokinetic data of antiretrovirals in pediatric patients. Recent findings Antiretroviral pharmacokinetic data in pediatric patients are limited. Recent data, however, continue to illustrate that antiretroviral pharmacology differs in children and adolescents when compared with adults. Summary This review describes our current understanding of pharmacology in pediatric patients and summarizes key pharmacokinetic data on antiretroviral agents presented over the past year. We briefly describe how pediatric pharmacology impacts future research and drug development of antiretroviral agents.