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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 .

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

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  1. 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

  2. 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

  3. 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 :

  4. 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

  5. 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

  6. Summary

  7. Revised simplified dosing

  8. 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

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