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IAP has given guidelines for management of HIV (pcr positive)infants and children which depends on either CD4 COUNT VIRAL LOAD OR CLINICAL STAGING.(A,B OR C) the problem is every time it is not possible to ge y viral load or cd4 count as they are costly .And depending on clinical staging only it is difficult to treat .as co relation of low cd4 count and infection may not be there. I mean they can be relatively asymptomatic. On the other hand Nelson mentions that every pcr positive infant should be treated irrespective of viral load and cd4 count .Please comment.
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Please note that PCR is the gold standard if done by standardised kits. However in India, most of the labs are doing an inhouse based PCR that does not have the same reliability.
Ref: Shah I. DIAGNOSIS OF PERINATAL TRANSMISSION OF HIV-1 INFECTION BY HIV DNA PCR. JK Science. 2004;6:187-189.
Regarding treatment, if not possible to do viral load, one must atleast do a CD4 count as one needs to monitor that while the child is on ART. Please remember that ART is never an emergency and one must start the same only when necessary. Read the book on MANAGEMENT OF PEDIATRIC HIV by Dr Ira Shah.
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