24811 - Guidelines for the Use of Antiretroviral Agents in...

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Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection DR. S.K CHATURVEDI DR. KANUPRIYA CHATURVEDI
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Antiretroviral (ARV) Therapy in Adults and Children Similar pathogenesis of HIV infection General virologic and immunologic principals for antiretroviral therapy apply Unique considerations in infants, children, and adolescents
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Special Considerations in Pediatric ARV Therapy Diagnostic issues Pharmacokinetic changes Availability of pediatric formulations Natural history differences in virologic and immunologic markers Adherence issues
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Changing Pharmacokinetics Age-related differences between children & adults Body composition Renal excretion Liver metabolism Gastrointestinal function Enzyme maturation Drug distribution, metabolism and clearance Drug dosing and toxicities Lead to potential differences in :
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Diagnostic Issues Early identification = all pregnant women must be offered HIV counseling and testing Perinatal infection = primary infection Early diagnosis = starting therapy during primary/early infection
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Diagnostic Issues in Infants HIV is diagnosed by 2 positive HIV virologic tests performed on blood samples 2 separate dates Use DNA PCR or HIV culture for diagnosing at: Birth (<48 hours) 14 days (optimal) 1–2 months 3–6 months
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Diagnostic Issues in Infants HIV is reasonably excluded with: 2 or more negative virologic tests One at age >1 month One at age > 4 months 2 or more negative HIV antibody tests at > 6 months (in the absence of breast feeding)
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Pediatric HIV Classification Age-Specific CD4 + Immunologic Categories Age of Child <12 months 1–5 years >6 years Immune Category Number/µL (%) Number/µL (%) Number/µL (%) Category 1 > 1,500 (> 25%) > 1,000 (> 25%) > 500 (> 25%) Category 2 750–1,499 (15–24%) 500–999 (15–24%) 200–499 (15–24%) Category 3 <750 (<15%) <500 (<15%) <200 (<15%)
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Pediatric HIV Classification Clinical Categories Category E:
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This note was uploaded on 02/22/2012 for the course HISTORY 308 taught by Professor St. john during the Spring '11 term at Rutgers.

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24811 - Guidelines for the Use of Antiretroviral Agents in...

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