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| SPECIALIST ANSWERS
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Question |
Hello madam/sir, I have a child 9 yr old put on AZT+3TC+NVP since 14 months with baseline Hb of 13.4gm, WBC 5000/cumm. On six months of treatment the CBC was within normal limits. Now she has developed pancytopenia with Hb 2.4 gm%, WBC1900/cumm, platelets 50000/cumm, MCV 109 fl. Could this be due to AZT(14 mon on treatment)? Do I need to change AZT?
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Answer |
The pancytopenia could be due to the drugs like ART, TMP-SMX, could be due to opportunistic infections such as mycobacterium avium complex, candida, hepatitis b, CMV, EBV and hepatitis C. It could also be due to myelofibrosis due to HIV itself. Also leukemia needs to be ruled out. Thus one needs to rule out all these conditions. What has been the CD4 count and viral loads of the patient? A marrow and bone biopsy will be required. Rule out OIs, leukemia, histiocytosis and HIV induced aplastic anemia. If all has been ruled out, one may try and omit the ART (NVP to be stopped suddenly and AZT/3TC should be stopped after a week to prevent NVP resistance).
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