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Question |
r/sir i have a child who is a known case of hiv +ve since two years and is on septran prophylaxis.she is put on 3drug ART since 6 months (lamuvudine ,zidu,nevirapine) presented with pancytopenia and low retic counts .suggesting bone marrow supression .plz tell me what shall i do next about the ART and how do i treat other than giving a transfusion for the anemia .what is the role of Gcsf in these children. her cd4 counts are very low and her age is 6 yrs.
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Answer |
One should rule out anemia due to drugs, opportunistic infections and due to HIV virus itself. You need to stop the septran and shift her to dapsone. Again zidovudine may need to be omitted as it is known to cause bone marrow suppression. Since the child is on 3 drug ART since 6 months and still has a low CD4 count, one needs to find out whether the child is drug resistant. In such a case shifting to a PI based regime along with abacavir and lamivudine/ddI would be useful. Rule out other OIs such as hepatitis B and Hepatitis C, CMV infection and mycobacterium infection (all of which can cause bone marrow suppression ).
G-CSF has been tried in few patients with neutropenia with limited success.
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