Treatment of HIV-Infected Children in Resource-Limited Countries

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Treatment of HIV-Infected Children in Resource-Limited Countries

Slide Presentation
October 24, 2007
Philippa Musoke, MD

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Treatment of HIV-Infected Children in Resource-Limited Countries

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Outline

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Epidemiology

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Morbidity and Mortality Prior to HAART

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Survival in the HAART Era

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Estimates of Children in Need of ARV and Cotrimoxizole (UNAIDS/UNICEF 2005)

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National Statistics: Uganda

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10-Point Management Plan: PAEDIATRIC HIV

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Prophylaxis for Opportunistic Infections in Sub-Saharan Africa

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Mortality: Children with HIV Antibiotic (CHAP) Trial

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Prevention of Malaria in HIV-Infected Children

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INH Prophylaxis

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Benefit of INH Prophylaxis

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Immunizations

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Challenges of Pediatric Antiretroviral Therapy in RLS

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WHO Guidelines for ART in Children

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Age-Specific Recommendations to Initiate ART

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Probability of Death within 1 Year by TLC in Ugandan Cohort

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First-Line Regimens

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Second-Line Regimens

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Problems with Specific ARVs in Children

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Monitoring HAART in RLS

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Failure in Children on HAART

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Decision-Making on Switching to Second-Line Therapy for Treatment Failure Based on Availability of CD4 Measurement

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Outcome of ART Stratified by CD4 Percentage at Baseline

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Distribution of Median CD4 Percentage over Time

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Response to HAART in Children: Mulago

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Median WAZ and HAZ Baseline and 12, 24, 36, 48, and 72 Weeks after Initiation of HAART

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Relying on Cutting Tablets in Half Is Not Always Feasible

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Blister Packs Make Administering of Drugs Easier

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Immunological Monitoring

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Clinical Monitoring

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Virologic Monitoring

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Clinical Diagnosis

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WHO Clinical Case Definition--Problems

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Response to HAART after sdNVP Exposure at Birth

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Single-Dose NVP Prophylaxis is Associated with NVP Resistance Acquisition in Infants Failing Prophylaxis--AZT and No Maternal NVP Dose May Reduce Resistance

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Figure 2. Time to Virologic Failure

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Response to NVP Containing HAART in sdNVP-Exposed vs Nonexposed Children

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Children Are NOT Small Adults: Clinically, Immunologically, Virologically

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Children Are NOT Small Adults: Drug Handling

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Challenges of Pediatric Antiretroviral Therapy in Resource-Poor Countries

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Response to HAART in Children: Mulago

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Image: 8-Year-Old Girl before HAART

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Same Girl after 6 Months of HAART

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ILA Program

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Distribution of Median CD4 Percentage over Time

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Log HIV RNA PCR at Baseline, 12, 24, 36, and 48 weeks

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Adherence Using Different Measures

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Distribution of Median CD4 Percentage over Time

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Psychosocial Support

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Younger Children in Peer Support Group

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Pediatric HIV Clinic in Mulago: Supported by Baylor College of Medicine

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Lessons Learnt

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Children's Peer Support Group: Executive Committee

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Major Challenges to Scaling Up Pediatric HAART

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Thank You

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