Page 52 - Children Bookt.pdf
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(d) In considering change of treatment because of growth failure, it should
be ensured that the child has adequate nutrition and that any intercurrent
infections have been treated and have resolved.
(e) Pulmonary or lymph node TB, which are clinical stage 3 conditions, may not
be an indication of treatment failure, and thus may not require consideration
of second-line therapy. The response to TB therapy should be used to evaluate
the need for switching therapy.
(f) CD4 measurement is best performed once the acute phase of the presenting
illness has resolved.
Clinical disease progression should be differentiated from IRIS. The worsening of
disease after initial clinical improvement or the development of a new or recurrent OI
soon after initiating ART in a child does not necessarily indicate treatment failure and
is not always an indication to stop or switch ART
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response to ART in relation to baseline CD4.
Providing the child is adherent to the therapy, immunological failure
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cell count) to pre-therapy baseline or below, in the absence of other concurrent
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A >50% fall from peak level on therapy of CD4 cell percent (or for children
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Developing or returning to the following age related immunological
thresholds after ART for at least 24 weeks
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( Preferably, at least two CD4 measurement should be done)
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Where regular access to viral load monitoring is available and affordable, it may
be used to identify treatment failure. Viral load is the most sensitive way to detect
viral replication. However, individual viral load values do not directly correlate with
clinically relevant outcomes (death or disease progression).
Virological failure
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regimen, more than 24 weeks from initiation of ART, and has a persistent viral load
over 5 000 copies/ml. In resource-limited settings it may not be feasible to perform
viral load testing. The availability of viral load is not a prerequisite for initiation of
ART or for the determination of treatment failure.
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