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Resistance to medication in babies
Feb 5, 2007

We have adopted a toddler who was infected at birth. His Dr. tells us that he is resistant to all the medications available for babies, and resistant to most everything else that is available. Phenotype testing shows the resistance. His Viral load and CD4 count fluctuate each time he has a test-sometimes high, sometimes declining. Why the fluctuations and if it is true that the HIV virus replicates most easily in brain cells, wouldn't developmental milestones and intellect then be affected? (Go Bears!)

Response from Dr. Sherer

Both viral loads and CD4 cell counts are more variable in children than in adults, and prone to greater and wider fluctuations. As you have probably heard, pediatricians use the CD4 percent, rather than the absolute number, because it is a more reliable and stable indicator of the child's immune status than the absolute number of CD4 cells, and it is less prone to such fluctuations. (The CD4 percent is also useful in adults with HIV infection).

Having resistance to all pediatric formulations also suggests the likelihood that the child is infected with a 'less fit' virus than wild type, which may be associated with lesser degrees of virulence and lower rates of diseaes progression than wild type virus.

HIV does establish itself in the central nervous system early in the course of infection, but the overall clinical impact of these events is variable. While you may see impairments in your child's developmental milestones and intellect, that is not inevitable.

Finally, I urge you to stay abreast with your doctor of new developments in HIV treatments, including new drugs to which your child's virus may be susceptible. There are several new compounds available for adults that will be made in pediatric formulations in future.


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