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8/6/2019 Paediatric HIV Myanmar
1/27
uav;oli,frsm;udk ARV aq;
wdkufauR;jcif;ESifhjyKpkapmufa&Smufjcif;;
Prepared By: Dr.Wut Yi Soe
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uav;oli,frsm;udk ART wif&mwGif
vdkufem&rnfh tcsufrsm;
START
(yxr tqifh aq;? &dK;&Sif;aom enf;vrf; jzifh p&ef)
SUBSTITUE
(aq;rwnfh vQif yxr tqifh aq;xJrS om ajymif;&ef)
SWITCH
(aq;,Of oGm;vQif rl 'kwd, tqifh aq; odkhajymif;&ef)
SALVAGE/STOP
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Vitoria, 2005
2 NRTI + 1
NNRTI
Start Substitute
1st Line
2 NRTI + 1
PI/r
Switch
2nd Line
PI/PI/r or strategic
recycling old drugs or
new ARV regimens
with 2nd
generationdrugs
Salvage
Salvage Stop
Lab Monitoring NeedsPill BurdenToxicity/Drug InteractiDrug CostReferral / Mentoring ne
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START
rnfonfhtcsdef wGif aq; p oif. oenf;/
rnfonfregimen ESifh poifh oenf;/
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ART p&rnfh Criteria
Clinical criteria (a&m*g vuPmpkrsm;)
Immunological criteria (CD4 tajc tae)
Virological criteria(Viral load tajc tae)
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Immunological assessment: CD4
1994 Revised Human Immunodeficiency
Virus Pediatric Classification
< 1year 1-5 year 6-12 year All age group
Immunologic category
1. no suppression >1500 >1000 >500 >25%
2. moderate 750-1499 500-999 200-499 15-24%3. severe
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Infants
1. Initiate ART for all HIV-infected infants diagnosed inthe first year of life, irrespective of CD4 count
or WHO clinical stage.
(uav; arG;uif;p rsm;wGif (1) ART udk touf wpf ESpf twGif; HIVydk;&dS onf [k owfrSwfxm;aom uav;rsm;udk ay;oifh onf/)
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Children
2. Initiate ART for all HIV-infected children between 12and 24 months of age irrespective of CD4
count or WHO clinical stage. (uav;rsm;wGif (2) ART udk touf wpfESpf rS ESpfESpf twGif; HIV ydk;&dS onf [k owfrSwfxm;aomuav;rsm;udk ay;oifh onf/)
3. Initiate ART for all HIV-infected children between 24and 59 months of age with CD4 count of 750 cells/mm3
or %CD4+ 25, whichever is lower, irrespective of WHOclinical stage.(touf 2 ESpf rS 5 ESpf twGif; CD4 count of750 cells/mm3 or %CD4+ 25 rSm pyg/ clinical stageudk tav; rjykygESifh)
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4. Initiate ART for all HIV-infected children more than 5years of age with a CD4 count of 350 cells/mm3 (as inadults), irrespective of WHO clinical stage.
(5 ESpf txuf qdk vQifCD4 350 atmuf qdk vQif ay;Edkif onf/) 5. Initiate ART for all HIV-infected children with WHO
clinical stages 3 and 4, irrespective of CD4 count.
(Clinical stages 3 and 4 qdkvQif aq;ay;Edkif onf/)
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6. Initiate ART for any child less than 18 months of agewho has been given a presumptive clinical diagnosis ofHIV infection.
(18 v atmufHIV/AIDS vuPm rsm;awG.vQif ay;oifhonf/)
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What to start recommended first-line ART regimens forinfants and
(yxr tqifh aq;? &dK;&Sif;aom enf;vrf; jzifh p&ef)
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rnfonfregimen ESifh poifh oenf;/
Infants (arG;uif;p uav;rsm; twGuf)
1) rdcif rS PMTCT twGufART raomuf ao;vQif
(2 NRTI s + NNRTI)2) rdcif rS PMTCT twGufART aomuf jyD;vQif
(lopinavir/ritonavir (LPV/r) + 2NRTIs)
3) aq;aomuf jyD;^rjyD; raocsmvQif(2 NRTI +NNRTI)
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rnfonfregimen ESifh poifh oenf;/
Children(uav;rsm; twGuf)
1) touf 12 v rS 24 v txd uav; rsm;wGif rdcif onfPMTCT rS ARTaomuf xm;vQif(lopinavir/ritonavir (LPV/r) + 2
NRTIs)
2) touf 12 v rS 24 v txd uav; rsm;wGif rdcif onfPMTCT rS ARTraomuf xm;vQif(2 NRTIs + NNRTI)
3) 24v ESifh 3ESpf Mum; qdkvQif(NVP + 2 NRTIs)3ESpfatmufwGifEFVrokH;&
4) 3 ESpf ESifh txuf qdkvQif(NVP/EFV + 2 NRTIs)
5) arG;uif;pInfants or childrentwGuf (2 NRTIs +NNRTI)rSm
Lamivudine (3TC) + zidovudine (AZT) or 3TC + abacavir(ABC) or 3TC + stavudine (d4T)
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rnfonfregimen ESifh poifh oenf;/
Infants(arG;uif;p) ESif. uav; rsm; twGuf txl;tajctae
touf3 ESpf ESifh txuf tuberculosis (TB) &SdvQifEFV + 2NRTIs regimen ay;oiHfhonf/
touf3 ESpf atmuf tuberculosis (TB) &SdvQifNVP + 2NRTIs regimen ay;oifhonf odkh a triple nucleosideregimen.
uav; rsm;ESifh tysdK? vlysdK azmf 0if t&G,f
aoG;tm;enf;vQif(
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aq;tnTef; (Austrillia)
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aq;tnTef; (NAP Guide line)
Zidovudine (AZT)= 10 mg/kg/dose twice daily
Stavudine (d4T)= 1mg/kg/dose twice daily
Lamivudine(3TC)= 4mg/kg/dose twice daily
Nevirapine (NVP)=7mg/kg/dose twice daily(8 yrs old)Initial once a day for 2 week
Efavirenz (EFV)= (only for the children over 3 years)
10-
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Uav;rsm; twGufvlMuD;aq;
rsm;udk csdK;wdkufjcif;
aumif;udsK;
vG,fulpGm&Edkif onf/
qdk;udsK;
wdusrIr&dS
BUT in many situations we have no choice!
decision to use adult FDC tablets in children (>1012 kg)
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Adult FDC tablets can successfully beAdult FDC tablets can successfully begiven to children who urgently needgiven to children who urgently need
HAART in resourceHAART in resource--limited settingslimited settings (RLS).(RLS).
OBrien DP et al AIDSOBrien DP et al AIDS 20062006
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ypnf;ud&d,mrsm; ESifh toHk;jyKyHk
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BWBW((kgkg))
GPOvirGPOvirdosagedosageQQ 1212 hrhr
66--88 11//44 tabtab
99--1111 11//22 tab,tab, 11//44tabtab
1212--1717 11//22 tabtab1818--2424 33//44 tabtab
>> 252511
tabtab
d4T 30 mg3TC 150 mgNVP 200 mg
1 cm
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d4T+3TC+EFV
BWBW dd44TT 33TCTC EFV*EFV*
(kg)(kg)
((3030mm
g)g)QQ 1212hrhr
((150150mgmg
))QQ 1212hrhr
((5050,, 200200
mgmg))QD hsQD hs
1212--11
44 cacapp
tab tab200200 mgmg
1515--11
77250250 mgmg--
Lamivudine
(150 mg)
stavudine
(30 mg)
efavirenz
1 cm.
(50mg)
(200 mg)
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yxr 6 v wGif Munfh&rnf
tcsufrsm;(on ART)prepration 1-2 Mo 3-4Mo 4-6 Mo
CounsellingSS(ESpfo dr faq G;aEG;jci f;)
ARVside effect(q dk;u sKd;)
Monitoring efficacy(aq ;\ x da&mu fr I)
Opportunistic infection(OI)
Immune Reconstitution Syndrome(IRIS)
Adherence monitoring
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ART rpcif ESpfodrfaqG;aEG;jcif;
ARV aq;udk rnfodk aomufrnfenf;
rnfolujyKpkapmifha&Smuf rnfenf;/
Adherence a&m*g vuPm rsm;awGvQif aq;cef;odk jyefvm&ef
tjzpfrsm;aom aq;qdk;usKd;rsm;udkajymjy xm;&ef
aq;cef;odk. rSefrSef jyefvm&ef? woufvHk;
aomuf&aomaq; jzpfaMumif; ajymjy&ef Uav;\ touf t&G,f ESifh tajctae t& zGifh[ajym qdkjcif;
twGuf pOf;pm;&ef
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Ttjzpfrsm;aom ARV qdk;usdK;rsm;
Symptoms ARV Timin
gPrevalence
Substitut
ions
Rash(teDjyif) NVP
EFV
2-4
week
2-4week
20-
30%
5-10%
EFV, PI
NVP, PI
Nausea, vomiting (rl;?tef) AZT 1-4
week
5-10% d4T
Night mare,
headahce(tdyfrufqdk;ruf?acgif;udkuf)
EFV 1-2
week
20-
30%
NVP
Anemia(aoG;eDOeJ) AZT 4-8 5-10% d4T
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aq;ay;jyD;aemuf uav;udk apmihfMunf.ukojcif;
aq;ay;jyD; yxr v wGif 1 ywf 1 cg csdef;yg/
'kwd, v wGif 2 ywf 1 cg csdef;yg
6 v txd 1 v 1 cg csdef;yg
6 vaemufydkif; wGif3 v 1 cg csdef; yg
uav; aeraumif;vQif &uf pdyfpdyf csdef;yg
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CD4 change after ARV %
5
11
13
16
21
2425 26
155
350
395
492
699745 759
718
0
5
10
15
20
25
30
35
40
0 8 24 48 72 96 120 144
Week of ART
CD4percen
tag
0
100
200
300
400
500
600
700
800
CD4cellco
un
CD4 percentage CD4 cells
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Growth change after receive ARV
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