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Six year old child, need HAART?
Aug 4, 2004

6 years old child, both parents died of Aids. Presented last year with TB and received a full course of TB treatment. At that time he had generalized Lymphadenopathy and failure to thrive. An HIV test was positive. When he finished his TB treatment, I asked for a CD4 and Viral Load. The results on the 14th. Jan. 2004 were CD4 487,5 - 12,5% and the viral load 26.912 copies/ml Hb 9.3 g/dl - WBc 7.500 - Lym 51,5 % -# 3.900. On the 9th. June 2004 he had a CD4 of 396 - 11.3% Now he is stable, with his Lymphadenopathy as before, and with no particular problems. His TB is radiologically and clinically cured. His weight and height is not increasing , but he is not losing weight. He had diarrhoea a few times which resolved easily. He has had some dermatitis but no oral candidiasis. According to our guidelines, children over 6 years are considered according to adult criteria for starting antiretrovirals. i.e. CD4 Percentages are ignored and ART is started when the CD4 is below 200. Since this child's CD4 is 396, he technically does not qualify for Antiretroviral Therapy.

1) Does he need Antiretroviral Therapy? 2)At what age does one apply adult critera for starting Antiretroviral Therapy?

Response from Dr. Luzuriaga

I would strongly consider antiretroviral therapy for this child. While absolute CD4 counts tend to normalize to adult values after the age of 5 or 6 years, the CD4 percentage of under 15% indicates severe immune depletion. His lack of growth also concerns me.

Is he on pneumocystis prophylaxis? Again, an absolute CD4 > 200 would not necessarily qualify him, but I would definitely consider it with a CD4 of 11-12%.

KL


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