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Starting children and infants on ART; what do the guidelines say?. Dr Siobhan Crowley Paediatric & Family HIV Care Department of HIV/AIDS World Heath Organization, Email: crowleys@who.int http://www.who.int/hiv/paediatric/en/index.html. WHO recommendations .

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starting children and infants on art what do the guidelines say

Starting children and infants on ART; what do the guidelines say?

Dr Siobhan Crowley

Paediatric & Family HIV Care

Department of HIV/AIDS

World Heath Organization,

Email: crowleys@who.int

http://www.who.int/hiv/paediatric/en/index.html

who recommendations
WHO recommendations
  • Published within adult guidelines in 2003
  • Stand alone August 2006
  • Include dosing instructions (Annex E)
  • Review meeting April 2008

http://www.who.int/hiv/pub/guidelines/art/en/index.html

http://www.who.int/hiv/paediatric/generictool/en/index.html

april 2008 technical reference group meeting
April 2008 –Technical Reference group meeting

For infants panel reviewed:

  • When to perform virological testing
  • When to start ART
  • What ARVS to start in infants with HIV

:

what art to start in infants 2008 revision
What ART to Start in infants –2008 revision

NVP triple ART

No infant or

maternal

ARV exposure

Baby 18%

Mum 34%

PI triple ART#

Sd NVP or NNRTI containing ART

MTCT ARV

Exposure

NVP triple ART

Non NNRTI exposure

Unknown infant

maternal MTCT

Exposure

NVP triple ART

# If no PI is available use NVP triple ART

children 1 year or over
Children 1 year or over

Clinical and/or

immunological criteria

to start ART

Standard first line regimen

NNRTI + 2NRTI

< 3 years

NVP + AZT + 3TC

> 3 years

EFV + AZT + 3TC

Standard second line regimen

PI + 2 new NRTI

acknowledgments r esources
Acknowledgments & resources:
  • HIV Care Technical Reference group
  • Paediatric ARV dosing working group:
    • Tony Nunn, Ed Caparelli, Shaffiq Essajee, Mark Mirochnick & Diana Clarke

Meeting report summarising these recommendations http://www.who.int/hiv/pub/paediatric/WHO_Paediatric_ART_guideline_rev_mreport_2008.pdf

Proceedings of the meeting

http://www.who.int/hiv/pub/meetingreports/art_meeting_april2008/en/index.html

2006 guidelines (being updated to reflect above)

http://www.who.int/hiv/pub/guidelines/art/en/index.html

Tool to assist in developing dosing recommendations

http://www.who.int/hiv/paediatric/generictool/en/index.html

A programming guide – how to scale up Paed care and treatment:

http://www.who.int/hiv/paediatric/Paeds_programming_framework2008.pdf

Paediatric HIV care landing page http://www.who.int/hiv/paediatric/en/index.html