Continued...

Category C: Severely Symptomatic

Children who have any condition listed in the 1987 surveillance case definition for acquired immunodeficiency syndrome, with the exception of LIP (which is a category B condition).

∗ Centers for Disease Control and Prevention. 1994 revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR, 1994. 43 (No. RR-12): p. 1-10.

Table 2 - Immune Categories Based on Age - Specific CD 4 T cell and Percentage

	< 12 mos		1- 5 yrs		6-12 yrs
Immune category	No./mm3	(%)	No./mm3	(%)	No./mm3	(%)
Category 1: No suppression	> 1,500	(>25%)	> 1,000	(>25%)	>500	(>25%)
Category 2 : Moderate suppression	750-1,499	(15%-24%)	500-999	(15%-24%)	200-499	(15%-24%)
Category 3: Severe suppression	<750	(<15%)	<500	(<15%)	<200	(<15%)

Modified from: CDC. 1994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR 1994; 43 (No. RR-12): p. 1-10.

Note: Sometimes absolute CD 4 cell count adjusted for age and CD 4 percentage may not fall in the same immune category. Thus, of the 2 parameters, whichever is in the lower category is taken into consideration before starting ART.

Which are the Anti-Retroviral Drugs?


Antiretroviral drugs consist of 3 main groups:-



Nucleotide Reverse Transcriptase Inhibitors consists of Tenofovir which is not recommended in children.


The NRTIs and NNRTIs competitively and non-competitively respectively inhibit the reverse transcriptase enzyme thus preventing translation of HIV RNA into HIV DNA in the host cell. The PIs inhibit the protease enzyme and thus cleavage of multiple HIV virions in the cell. Thus, the antiretroviral decrease the HIV viral load in the body. However, all the antiretrovirals to first act requires the HIV virus to first infect the human cell. There are a new class of antiretroviral drugs now available called "FUSION INHIBITORS" that inhibit the entry of HIV virus into the host cell. Thus, they act extracellularly. However, at present they are recommended only in adults who have failed their primary regimes and not recommended in children as they need to be given as subcutaneous injections at least twice a day and compliance is a major problem.