Page 53 - Children Bookt.pdf

Y\[ Decision-making on switching to second-line ART for treatment failure
"$%!!
New or recurrent Availability of CD4
Management options
clinical event on ART measurement
No CD4 Do not switch regimen
Stage 1 or stage 2
event CD4 Consider switching regimen only if
two or more values are below the
age-related threshold
Increase clinical and CD4 follow-up
if CD4 value approaches the age-
related threshold
Measure VL if available

No CD4 Manage event and assess response
- Switching regimen is recommended
CD4
if CD4 value is below the age-
related threshold and particularly
if the child initially had a good
Stage 3 event
immune response to ART
- Measure VL if available
- Increase clinical and CD4 follow-
up if CD4 value approaches age-
related threshold

#% No CD4 Consider switching regimen
CD4 Switching regimen is
recommended if CD4 value is
below the age-related threshold
and particularly if the child
initially had a good immune
response to ART
Switching may not be necessary
where CD4 value is above
age-related threshold
VL testing may resolve discordant
CD4 results

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