Existing WHO recommendations for Paediatric ART under review

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Presentation transcript:

Existing WHO recommendations for Paediatric ART under review WHO Paediatric Guideline Group meeting Geneva, SWITZERLAND Salle D 10 - 11 April 2008

Recommendation 1- when to start ART in infants Intervention Reco QoE Comment CD4 < threshold for severe immunodeficiency, irrespective of clinical stage. CD4< 1500 %CD4 <25 Strong High stage 4 irrespective of CD4 Moderate stage 3 irrespective of CD4

Recommendations 2- testing in infants Intervention Reco QoE Comment At or around 6 weeks of age is most efficient time at which to perform a viral test for an HIV exposed infant Strong Low Programmatic expedience governed this recommendation- most infants are seen at this time and sensitivity and specificity for detection of infection acquired at or around delivery is >95% Presumptive diagnosis of severe HIV may be made on clinical grounds with a history of HIV exposure and positive HIV antibody testing Very low Pragmatic and based on fact that early diagnosis not yet universally available

Recommendations 3 - what to start Infants Intervention Reco QoE Comment 2 NRTI + Nevirapine (AZT + 3TC + NVP) preferred (d4T+ 3TC + NVP) Strong Moderate In severe anaemia -d4T for AZT 3 X NRTI (AZT+ 3TC + ABC) Conditional Low TB co therapy, hepatitis, PI + 2NRTI (AZT + 3TC + Lop/r) Not recommended Not stated Preserve for 2LT