3.30 MB - Academy of Medicine of Malaysia

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MANAGEMENT OF HIV INFECTION IN CHILDREN failure (n=14) and resistance (n=6). This was attributed to unreliable plasma levels of NFV in young infants. More recent studies suggest the need for higher doses of both NFV and NVP to achieve better viral suppression in young infants. There is some evidence to suggest that very early treatment of confirmed HIV infected infants is feasible and moderately effective regardless of CD4% or cell counts. Faye 148, Level 6 noted that young infants who started HAART
Evaluation prior to initiating antiretroviral treatment Carry out a detailed clinical evaluation prior to initiating antiretroviral therapy to assess the clinical stage of HIV infection, identify past HIVrelated illnesses, identify current HIV-related illnesses that would require treatment and identify co-existing medical conditions and treatments that may influence the choice of therapy. Fully assess the ability of the child and the caregivers to adhere to the treatment before initiating HAART regimen. Intensive education of the child and caregivers about the importance of adherence to regimen should be provided before therapy is initiated. Recommendation for when to initiate treatment Ensure that the child and caregivers will be adherent to the HAART regimen. (Grade C) HIV infected infants < 12 months Initiate HAART in infants who are symptomatic (WHO Stage 2, 3 or 4) irrespective of CD4 or viral load (Grade B) Initiate HAART in infants who are asymptomatic (WHO Stage 1 and CD4 1 year MANAGEMENT OF HIV INFECTION IN CHILDREN Initiate HAART in children with AIDS or significant symptoms (WHO Stage 3* or 4) irrespective of CD4 and viral load (Grade B) Initiate HAART in asymptomatic or mildly symptomatic children (WHO Stage 1 or 2) who have met age-related CD4 threshold for treatment (refer to Table 2 for details) (Grade B) Consider HAART in asymptomatic or mildly symptomatic children (WHO Stage 1 or 2) who have either met age-related CD4 threshold (refer Appendix 4) or have viral load > 100,000 copies (see Table 2) (Grade B) Defer HAART in asymptomatic or mildly symptomatic children (WHO Stage 1 or 2) who have no immune suppression and viral load
Page 2 and 3: This Guideline is intended a guide
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Page 8 and 9: REVIEW COMMITTEE The draft guidelin
Page 12 and 13: TABLE OF CONTENTS MANAGEMENT OF HIV
Page 84 and 85: 71 Appendix 2 WHO CLINICAL STAGING
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MANAGEMENT OF HIV INFECTION IN CHIL
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Appendix 6 MANAGEMENT OF HIV INFECT
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Appendix 7 MANAGEMENT OF HIV INFECT
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3.30 MB - Academy of Medicine of Malaysia

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