24821 - Indications for Initiation of ARV Therapy in...

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Indications for Initiation of ARV Therapy in Children Age >1 Year Clinical Category CD4 + Cell Percentage Plasma HIV RNA Copy Number Recommendation AIDS (Clinical Category C) OR <15% (Immune Category 3) Any Value Treat Mild-Moderate Symptoms (Clinical Category A or B) OR 15–25% (Immune Category 2) OR >100,000 copies/mL 2 Consider Treatment Asymptomatic (Clinical Category N) AND >25% (Immune Category 1) AND <100,000 copies/mL 2 Many experts would defer therapy and closely monitor clinical, immune and viral parameters
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Choice of Initial ARV Therapy Use ZDV monotherapy only for prophylaxis in indeterminate infant in first 6 weeks of life Use combination ARV therapy with at least 3 drugs Slows disease progression Improves survival Sustains virologic response better Delays development of resistance
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Choice of Initial ARV Therapy Maximal suppression of viral replication to undetectable levels, if possible, for as long as possible Preservation or restoration of immune function Prevention of complications of HIV infection, including opportunistic infections The goals of ARV therapy are:
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Choice of Initial ARV Therapy Consideration of resistance testing before initiation of therapy in newly diagnosed infants <12 months Particularly if mother has known or suspected drug-resistant virus The Working Group recommends:
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Recommendations on ARV Regimens for Initial Therapy Data demonstrating durable viral suppression, immunologic and clinical improvement Incidence and types of drug toxicity Availability/palatability of formulations for children Dosing frequency, food and fluid needs Potential for drug interactions Working Group criteria:
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Types of ARV Regimens for Children PI-based (2 NRTIs + PI) NNRTI-based (2 NRTIs + NNRTI) NRTI-based (3 NRTIs)
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for Initial Therapy Strongly recommended
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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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24821 - Indications for Initiation of ARV Therapy in...

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