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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3.2.6 Management <strong>of</strong> medication toxicity or intolerance<br />
• If a child has severe or life-threatening toxicity, all components <strong>of</strong> the<br />
drug regimen should be stopped immediately. Once the symptoms<br />
<strong>of</strong> toxicity have resolved, antiretroviral therapy should be resumed<br />
with substitution <strong>of</strong> another antiretroviral drug for the responsible<br />
drug.<br />
• Children with moderate medication toxicity should continue on<br />
antiretroviral therapy when possible while an assessment is done to<br />
identify and substitute for the <strong>of</strong>fending agent.<br />
• Children with mild toxicity can be treated symptomatically, and do<br />
not require drug discontinuation or change in drug therapy.<br />
• When changing therapy because <strong>of</strong> toxicity or intolerance to a<br />
specific drug, changing a single drug in a multi-drug regimen is<br />
permissible; if possible, an agent with a different toxicity and side<br />
46, Level 9<br />
effect pr<strong>of</strong>ile should be chosen.<br />
3.2.7 Short-term therapy interruption<br />
MANAGEMENT OF HIV INFECTION IN CHILDREN<br />
• Short-term interruptions <strong>of</strong> ARV drugs may be indicated in some<br />
situations such as serious treatment-related toxicity, acute illness or<br />
surgery.<br />
• When short-term interruptions are required, then all antiretroviral<br />
drugs should be stopped at the same time, if these medications<br />
have similar half-lives.<br />
• However when agents with long half-lives are used (especially the<br />
NNRTIs EFV and NVP) cessation <strong>of</strong> all ARVs simultaneously could<br />
result in functional monotherapy with risk <strong>of</strong> resistance to these<br />
agents. To prevent functional monotherapy, some experts<br />
recommend stopping the NNRTI component first and continuing the<br />
other ARV drugs for a period <strong>of</strong> time (the optimum duration still not<br />
known - WHO recommends a one-week tail <strong>of</strong> the NRTI drugs).<br />
• In case <strong>of</strong> serious or life-threatening ARV therapy toxicity, all drugs<br />
should be stopped immediately.<br />
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