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Appendix 7 MANAGEMENT OF HIV INFECTION IN CHILDREN Treatment for opportunistic Infections* Other options/issues Alternative therapies Preferred therapies and duration Pathogen Indications for corticosteriods: - PaO2 35 mm Hg Continue secondary prophylaxis Intolerant or clinical treatment failure after 5-7 days of TMP/SMX therapy: Pentamidine 4 mg/kg body weight intravenously once daily Trimethoprim-sulfamethoxazole (TMP/SMX) 15-20 mg/kg body weight TMP plus 75-100 mg/kg body weight SMX administered IV or Oral 3 or 4 times daily for 21 days Pneumocystis jiroveci pneumonia Pyridoxine should be administered if isoniazid is administered Alternative drug for ethambutol is streptomycin Intensive Mycobacterium tuberculosis (TB) In antiretroviral-naïve child, initiate therapy for TB 4-8 weeks before starting antiretroviral drugs Optimal timing of commencement of HAART in newly diagnosed HIV infected children with TB disease remains unclear. In general, antiretroviral therapy should be commenced at least 1-2 months after commencement of antituberculous therapy. For children already on HAART when TB is diagnosed, treatment should be continued however alteration of drug combinations may be required to minimize potential toxicities and drugdrug interactions. Ethionamide should be used for tuberculosis meningitis Isoniazid (INH) 10-15 mg/kg(max: 300 mg/day) oral daily Rifampicin 10-20 mg/kg body weight (max:600 mg/day) oral daily pyrazinamide 20-40 mg/kg (max: 2 g/day) body weight oral daily ethambutol 15-25 mg/kg body weight (max: 1.0 g/day) oral daily 83 Treatment duration Pulmonary TB: 9 months for HIV infected child Continuation phase (for drug sensitive TB): Daily: Isoniazid 10-15 mg/kg body weight (max: 300 mg/day) oral daily plus rifampicin 10-20 mg/kg body weight (max: 600 mg/ day) oral daily OR Intermittent: Isoniazid 20-30 mg/kg body weight (max: 900 mg/day) by mouth once daily administered two to three times a week plus rifampicin 10-20 mg/kg body weight (max: 600 mg/day) by mouth once daily administered two to three times a week
Appendix 7 Other options/issues Alternative therapies Preferred therapies and duration Pathogen Pienaar,Young & Holmes Cochrane Database 2006 Fluconazole 3-6 mg/kg body weight (max: 400 mg/dose) by oral daily for 7-14 days Oropharyngeal Candida Due to only one study in children it is not possible to make recommendations for treatment or prevention of oropharyngeal candidiasis (fluconazolerefractory): Itraconazole cyclodextrin oral solution 2.5 mg/kg body weight by mouth twice daily (max: 200 - 400 mg/day) for 7-14 days OR Amphotericin B oral suspension 1ml (100 mg/ml) by mouth four times daily for
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This Guideline is intended a guide
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MANAGEMENT OF HIV INFECTION IN CHIL
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REVIEW COMMITTEE The draft guidelin
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TABLE OF CONTENTS MANAGEMENT OF HIV
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3.30 MB - Academy of Medicine of Malaysia

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