3.30 MB - Academy of Medicine of Malaysia
3.30 MB - Academy of Medicine of Malaysia
3.30 MB - Academy of Medicine of Malaysia
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MANAGEMENT OF HIV INFECTION IN CHILDREN<br />
3. MANAGEMENT OF HIV INFECTED INFANTS, CHILDREN<br />
AND ADOLESCENTS<br />
Management <strong>of</strong> HIV-1 infected children requires monitoring <strong>of</strong> disease<br />
progression, timely commencement <strong>of</strong> a potent HAART regimen, monitoring<br />
<strong>of</strong> treatment, assessing response and adverse reactions.<br />
3.1 MONITORING DISEASE PROGRESSION<br />
Monitoring <strong>of</strong> disease progression <strong>of</strong> the HIV-1 infected child is through<br />
clinical, immunological and virological means.<br />
3.1.1 Clinical<br />
There are two major systems for clinical classification <strong>of</strong> HIV infection in<br />
children: the WHO Clinical Classification and the CDC Classification<br />
System. The guideline development group has chosen to adopt the WHO<br />
classification for <strong>Malaysia</strong> (refer Appendix 1 and 2).<br />
3.1.2 Immunologic<br />
Immunologic monitoring is done by serial evaluations <strong>of</strong> the CD4 lymphocyte<br />
count and percentage. HIV associated immunodeficiency is defined as not<br />
significant, mild, advanced and severe according to age-related cut-<strong>of</strong>f<br />
values <strong>of</strong> CD4% and count (refer Appendix 3).<br />
3.1.3 Virologic<br />
Virologic monitoring is by the use <strong>of</strong> plasma viral load (pVL) assays. Current<br />
R<br />
methods used are the Roche Amplicor HIV-1 Monitor System - standard<br />
R<br />
and ultrasensitive and the Roche COBAS Taqman HIV-1 . The lower limits<br />
<strong>of</strong> detection vary with the type <strong>of</strong> assay (Amplicor standard