Management of Hiv

8/3/2019 Management of Hiv

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MANAGEMENT OF HIV


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Diagnosis of HIV infection in children

HIV serological assays:

18 months of age

used as a diagnostic assay

sensitivity of 99%

specificity of 98%


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HIV virological assays

used to diagnose HIV infection in infants andchildren less than 18 months of age.

HIV DNA on whole blood specimen or dried bloodspots (DBS)

HIV RNA on plasma or DBS

ultrasensitive p24 antigen (Up24 Ag) on plasma or

DBS

sensitivity of 95%

specificity of 98%


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It is strongly recommended that well, HIV-exposedinfants undergo HIV serological testing at around 9

months of age .Those who have reactive serologicalassays at 9 months should have a virological test to

identify infected infants who need ART.

Infants with signs or symptoms suggestive of HIVinfection undergo HIV serological testing and, if

positive (reactive), virological testing.


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TREATMENT


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ANTIRETROVIRAL THERAPY IN PREGNANCY

1. ARV PROPHYLAXIS: A) MATERNAL AZT REGIMEN

B) TRIPLE ARV PROPHYLAXIS REGIMEN

from 14 wks gestation until 1 week after all

exposure to breastmilk has ended

2. ART : STAGE 3, 4 OR CD4 COUNT < 350cells/mm3

Continue thereafter


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Recommendations for initiating ART in

infants and children


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Recommendations for initiating ART in HIV-

infected infants and children according to clinical

stage and immunological markers

a

Stabilize any opportunistic infection (OI) before initiating ART.

bBaseline CD4 is useful for monitoring ART even if it is notrequired to initiate ART.


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ARV DRUGS are broadly classified by the

phase of the retrovirus life-cycle that the

drug inhibits: 1. Non-nucleoside reverse transcriptase inhibitors

(NNRTI): Efavirenz ,Nevirapine

2. Nucleoside reverse transcriptase inhibitors(NRTI):Zidovudine, Didanosine ,Zalcitabine ,Stavudine ,Lamivudine

3. Protease inhibitors : Ritonavir, indinavir 4. Entry inhibitors :Enfuvirtide

5. CCR5 receptor antagonists

6. Integrase inhibitors: Raltegravir
http://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Protease_inhibitor_(pharmacology)http://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Ritonavirhttp://en.wikipedia.org/wiki/Indinavirhttp://en.wikipedia.org/wiki/Entry_inhibitorshttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Enfuvirtidehttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Discovery_and_development_of_CCR5_receptor_antagonistshttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Integrase_inhibitorhttp://en.wikipedia.org/wiki/Discovery_and_development_of_CCR5_receptor_antagonistshttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Discovery_and_development_of_CCR5_receptor_antagonistshttp://en.wikipedia.org/wiki/Discovery_and_development_of_CCR5_receptor_antagonistshttp://en.wikipedia.org/wiki/Integrase_inhibitorhttp://en.wikipedia.org/wiki/Integrase_inhibitorhttp://en.wikipedia.org/wiki/Integrase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Discovery_and_development_of_CCR5_receptor_antagonistshttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Enfuvirtidehttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Entry_inhibitorshttp://en.wikipedia.org/wiki/Indinavirhttp://en.wikipedia.org/wiki/Ritonavirhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Protease_inhibitor_(pharmacology)http://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitorhttp://en.wikipedia.org/wiki/Reverse_transcriptase_inhibitor


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RECOMMENDED FIRST-LINE ARV

REGIMENS FOR INFANTS AND CHILDREN

< 24 months

1. Not exposed to ARVs: ART with nevirapine(NVP) + 2 nucleoside reverse transcriptase inhibitors

(NRTIs).

2. Exposed to maternal or infant NVP or otherNNRTIs used for maternal treatment: ART with

lopinavir/ritonavir (LPV/r) + 2 NRTIs.


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For children more than 24 months and less than 3years of age : ART with NVP + 2 NRTIs.

For children 3 years of age and above: ART with anNVP or efavirenz (EFV)-containing regimen + 2NRTIs.


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ARV DRUG TOXICITY

Toxicity event Responsible ARV

Severe anemia or neutropeniaLactic acidosis

Severe gastrointestinal intolerance

ZIDOVUDINE

Lactic acidosis

Peripheral neuropathyPancreatitis

STAVUDINE

Acute symptomatic hepatitisHypersensitivity reaction

NEVIRAPINE

Persistent and severe central nervoussystem toxicityPotential teratogenicity

EFAVIRENZ


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After failure on a first-line NNRTI-based regimen, aboosted PI plus 2 NRTIs are recommended for

second-line ART.


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THANK YOU

Management of Hiv

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