BOSTON — By some estimates, around 1,800 children, mostly newborns, become infected with HIV each day. But even though the stakes are high, the most commonly used strategy to combat the deadly virus among infected children in resource-limited countries may need a massive overhaul. According to data presented here last month at the Conference on Retroviruses and Opportunistic Infections, babies born with HIV should immediately start receiving antiretroviral drugs known as protease inhibitors, not the reverse transcriptase inhibitor widely used throughout the developing world.

“We have created a bit of a stir at the guideline level moving forward,” says Paul Palumbo, a pediatrician at Dartmouth Medical School in Hanover, New Hampshire. “We need to move into considerations of using [protease inhibitors] as a first-line therapy.”

The reverse transcriptase–blocking drug nevirapine, marketed as Viramune by the German company Boehringer-Ingelheim, is the cornerstone of both preventing mother-to-child transmission of HIV and treating infections in affected infants in the third world, where the vast majority of the world’s 2.1 million HIV-positive children live. But in children who become infected despite receiving nevirapine as prophylaxis, the drug often selects for resistant viruses. To avoid using the same medicine for prophylaxis and treatment, researchers have sought a different drug regimen for kids once they become infected, and a protease inhibitor called Kaletra — a formulation of ritonavir-boosted lopinavir developed by Chicago-based Abbott Laboratories — has emerged as the front-runner.

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