| Answered By
Dr. owen osanoOn :
24 Apr 2008
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According to ART guidelines clinicians are suposed
to change the child on another ART with re-enforced adherence and close-up look on the child if really the the care taker was giving the medication,best should be in the wards.
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| Answered By
Dr. owen osanoOn :
24 Apr 2008
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rule out causes of wbc abnormalities eg. bone murrrow suppression, nutritional deficiency.
CD4 might have been too low initially, give it time.
do viral load to acertain virologic failure.
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| Answered By
Dr. Gareth Tudor-WilliamsOn :
23 Apr 2009
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This is not uncommon. Around 5 of HIV infected children who respond well both clinically and - if you can measure it - virologically, have poor CD4 count responses. It is most often associated with a very low baseline CD4 count prior to starting ARVs. It may be associated with other co-infections such as CMV, TB or non-tuberculous mycobacterial infections.
The ARROW trial is currently following around 1,200 HIV-infected children in Uganda and Zimbabwe. They are randomised to 3 different first line ARV arms, and 2 different monitoring strategies. The trial will provide some much-needed evidence regarding longer term clinical outcomes for children on first line ARVs in precisely your setting, but dont hold your breath as it will not be reporting until 2011!
In the meantime, I think you should continue supporting this girl to take her first line ARVs with the best possible adherence. I would not recommend switching therapy for a poor CD4 count response alone.
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| Answered By
Dr. Suresh upadhyayOn :
24 Mar 2008
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1-DRUG RASISTENCE
2-CD4 CAN TAKE TIME TO INCREASE.CONT ART IF CLINICAL IMPRROVEMENT IS THERE
3-VL IF POSSIBLE
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| Answered By
Dr. Syed MeesumOn :
02 May 2008
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| plz. detail the ARV drugs in use and about management of co-infection in any. wt. was the base line CD4 count.
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| Answered By
Dr. nishant atkareOn :
15 May 2008
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| wait for the response for atleast 3 months.repeat cd4 counts if the clinical stage is stable and cd 4 is still not showing improvement then go for viral load if possible..if viral load is not possible again wait for 3 months repeat cd4 change to second line if no improvement in cd4 or clinical deterioration is evident
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| Answered By
Dr. Sanjiv LewinOn :
01 Feb 2009
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May I suggest the following:
1. History: How old is the child How long has the child been on adherent ART so far Has there been prior exposure to ARVs NVP sd ARVs containing NNRTIs, etc Where is your site located....how far from a site that could do Viral Loads
2. What was her initialfollow up CD4, CD4 and baselinefollow up WHO Clinical Staging
3. How was the conclusion made that adherence was good recall, patient reporting, pill count How good is good If on ZDV is there indirect evidence such as macrocytosis Confirm the body weight based doses of each drug used in the regimen What regimen is being used....standard Uganda government regimen or someother
Once we have this information and we are absolutely certain about 95adherence it is really worth trying to get a Viral Load documented through any program ongoing nearby eg. AIDSRelief-Uganda- IHVCRS.....I could get you in contact with them before labeling the child to have Treatment Failure. If not feasible then use WHO Treatment failure criteria if atleast 6 months of ART has been adhered to and preferably then refer as your options are rather limited in the Uganda setting.
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| Answered By
Dr. Sanjiv LewinOn :
03 Feb 2009
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| We really need to know how long the child has been on ART What were the baseline and follow up Clinical Stage, absolute CD4, CD4 and weights Also what were the measures of adherence....pill counts, directly observed, pharmacy records, etc The age of the child is vital for we too had an adolescent orphan child in Africa throwing out her pills deligently and showing poor unexplained response Are there other family members at home sharing ARVs If at least 6 months of ART has been completed and all the above are all suggestive of unexplained poor CD4 response then you must try and get a viral load done.....find out any program EG. AIDSRelief - CRS, Uganda....contact Dr. Anthony Edozien or Dr. Orhan in Kampala that can help you with this for it will really be the only way to confirm treatment failure.....Of course, you will remember that nonadherence is probably the commonest cause for poor response!
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| Answered By
Dr. Sarah TaaffeOn :
06 May 2009
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Regarding this little child.ARV therapy is the child on,
What is the situation with the childs mother, considering resistance secondary to the mothers medication history, compliance etc. and of course how long has the child been on ARVs.
Is there the possibility to obtain a viral load in your setting
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| Answered By
Dr. consuela marcasOn :
26 Sep 2009
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| rezistence tets to ARV,
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