Antiretroviral Therapy Absolute and Relative Indications in HIV Child

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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ANTIRETROVIRAL THERAPY IN HIV POSITIVE CHILDREN

Indications For Starting Antiretroviral Therapy

Related topics

Initiation Of Antiretroviral Therapy

Dr Ira Shah
MD, DNB, DCH, FCPS
Pediatrician & Pediatric HIV Specialist

Absolute indications

Any child with AIDS or clinical category C
Any child with CD 4% <15% or in immune category 3.
A child less than 12 months of age in clinical category B or C or immune category 2 or 3 (CD 4% <25%).

Relative Indications

HIV RNA PCR (viral load) > 100,000 copies/ml in a child > 1 year of age ^.
A child more than 1 year of age in clinical category A or B or immune category 2 (CD 4% = 15-25%)*.

^ Plasma HIV RNA levels are higher in HIV infected infants than older infected children and may be difficult to interpret in infants <12 months of age

* Most experts would initiate therapy if CD 4 cell percentage is between 15 to 20% and defer therapy with increased monitoring frequency in children with CD 4 cell percentage 21% to 25%.

Table 1- 1994 Revised Pediatric Classification System: Clinical Categories for HIV infection

Category N: Not Symptomatic

Children who have no signs or symptoms considered to be the result of HIV infection or who have only one of the conditions listed in category A.

Category A: Mildly Symptomatic
Children with two or more of the following conditions but none of the conditions listed in categories B and C:

Lymphadenopathy (>0.5 cm at more than two sites; bilateral = one site)
Hepatomegaly
Splenomegaly
Dermatitis
Parotitis
Recurrent or persistent upper respiratory infection, sinusitis, or otitis media

Category B: Moderately Symptomatic
Children who have symptomatic conditions, other than those listed for category A or category C, that are attributed to HIV infection. Examples of conditions in clinical category B include but are not limited to the following:

Anemia (< 8 gm/dL), neutropenia (<1,000/mm3), or thrombocytopenia (<100,000/mm3) persisting >30 days
Bacterial meningitis, pneumonia, or sepsis (single episode)
Candidiasis, oropharyngeal (i.e., thrush) persisting for >2 months in children aged >6 months
Cardiomyopathy
Cytomegalovirus infection with onset before age one month
Diarrhea, recurrent or chronic
Hepatitis
Herpes simplex virus (HSV) stomatitis, recurrent (i.e., more than two episodes within one year)
HSV bronchitis, pneumonitis, or esophagitis with onset before age one month
Herpes zoster (i.e., shingles) involving at least two distinct episodes or more than one dermatome
Leiomyosarcoma
Lymphoid interstitial pneumonia (LIP) or pulmonary lymphoid hyperplasia complex
Nephropathy
Nocardiosis
Fever lasting >1 month
Toxoplasmosis with onset before age one month
Varicella, disseminated (i.e., complicated chickenpox)

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