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close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
Open this folder and view contentsCHAPTER 6: HIV/AIDS AND PREGNANCY
Open this folder and view contentsCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
Open this folder and view contentsCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
Open this folder and view contentsCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
Open this folder and view contentsCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
close this folderCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
View the document13.1 Antiretroviral regimens for HIV infected children
View the document13.2 Goals of Antiretroviral Therapy in children
View the document13.3 Selection of Patients for Antiretroviral Therapy
View the document13.4 Recommended First-Line ARV Regimens in Infants and Children
View the document13.5 Clinical Assessment of Infants and Children Receiving ARV Therapy
close this folder13.6 Reasons for Changing ARV Therapy in Infants and Children
View the document13.6.1 Clinical Conditions
View the document13.6.2 Immunological Conditions
View the document13.6.3 Virological Conditions
View the document13.7 Recommended Second-Line ARV Therapy for Infants and Children
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
Open this folder and view contentsCHAPTER 15: HIV/AIDS AND NUTRITION
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

13.6.3 Virological Conditions

Virological conditions indicating that a change to second-line therapy is warranted include:

Persistently elevated viral load in the absence of poor adherence to medication

Progressive increase in viral load after the beginning of treatment (changes greater than 5-fold (0.7 log) in children less than 2 years of age, and of at least 3-fold (0.5 log) in children 2 years of age or older

< 1.0 log reduction in relation to the initial level after 24 weeks

Repeated viral load detection in children with earlier undetectable levels.

Before an ARV regimen is thought be failing based on clinical criteria, the child should have had a reasonable trial on the ARV therapy (e.g., have received the regimen for at least 6 months).

Because of age-related declines in CD4 absolute cell count through age 6 years, when near-adult levels are reached, it is difficult to use absolute CD4 cell count to assess failure of therapy in younger children. However, for children aged 6 years or more, similar CD4 cell count criteria as used in adults is appropriate. Because CD4 cell percentage varies less with age, it can be used to gauge treatment response regardless of age. Data on use of total lymphocyte count to evaluate response to ARV therapy are not available.

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