(精选)Paediatric Antiretroviral Therapy教学课件.pptVIP

Finer Details New Eligibility for Antiretroviral Therapy for SA DOH Clinical Criteria ? ? Social criteria At least one identifiable caregiver who is able to supervise child or administer medication Disclosure to another adult living in the same house is encouraged so that there is someone else who can assist with the child’s ART Treatment of mother/caregiver/other family members ? Under 5 years All children Any CD4 count 5 years- WHO stage III, IV CD4 350 cells/μl ART Eligibility for children Fast Track (i.e. start ART within 7 days of being eligible) Children less than 1 year of age WHO clinical Stage 4 MDR or XDR-TB CD4 Count 200 cells/ul or 15%  CHOOSING a REGIMEN NRTI Backbone (2 NRTIs) + Protease Inhibitor(PI) OR NNRTI * NRTI Backbone Popular choices D4T + 3TC (high incidence of lipodystrophy) AZT + 3TC (compromises 2nd line backbone (d4T+ddI)) 3TC+ABC AVOID d4T + ddI FIRST LINE * Abacavir +3TC Backbone Can’t use Tenofovir routinely in children because of osteopaenia and nephrotoxicity Very good long term data from PENTA 5 Spares Thymidine analogue for next regimen Both drugs select for the same résistance pathway(M184V) Abacavir should only be used for 1st line (Without Genotyping) ( 3 TAMS + M184V confers high level resistance) Hypersensitivity linked to HLA B*5701 HLA B*5701 rare in Black population HSR 5% in whites, 0.2% in Blacks Abacavir Hypersensitivity Reaction Therefore If you stop Abacavir for a suspected Hypersensitivity reaction, you can NEVER give the patient Abacavir again Abacavir Hypersensitivity reaction A sign or symptom in two or more groups Abacavir Hypersensitivity Reaction May or may not be accompanied by rash Systemic symptoms, may be severe Multisystem disorder Usually in first 6 weeks of treatment Gets visibly worse with each dose Have been fatalities with rechallenge Abacavir Hypersensitivity Reaction Hypersensitivity linked to HLA B*5701 Blood test available in South Africa but not frequently requested Why not