3.30 MB - Academy of Medicine of Malaysia

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