de la transmission mreenfant du VIH预防艾滋病母婴传播课件.ppt

HIV in Children and early detection CBSK ZNA Koningin Paola Kinderziekenhuis ARC: ZNA/UZA/ITG Philip Maes – Bart Peeters – Myriam Willems – Elke De Belder 21 December 2006 Child with HIV: what to do? Child with HIV: what to do? HAART Highly Active Anti Retroviral Therapy ? Dramatic fall in child and adult mortality from HIV infection in Europe ? Very expensive ? major impact on the family ? Wide variation in prescribing practice across Europe: from 50% to 97% in different countries ? Problems of compliance/adherence Diagnosis ELISA Western Blott PCR virale lading Guidelines for HAART in HIV + children U.S.A.: 1993: Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children: convened by the NPHRC, HRSA NIH 1998: CDC: MMWR: April 17, 1998/Vol.47/No. RR-4 2005: Most recent update Nov. 05, 2005. Europe: 09/99: Current evidence for the use of Pediatric Antiretroviral Therapy - A PENTA Analysis Belgium: National Pediatric Working group every 3 months with review of the guidelines once a year When to start HAART ? - No randomised trial evidence is available - So decisions to start are based on: clinical disease stage? viral load ? CD4% ? cfr.: CDC 1994 Revised classification system for HIV infection in children less than 13 years of age. - AIDS stadium or not ? - Age ? Basic principles for HAART in HIV + children 1. Importance of clinical trials in children 2. Management of prescribing HAART is becoming increasingly complex and should wherever possible be directed in specialised centres by a multidisciplinary team 3. Regular monitoring (clinical/biochemical/psycho-social) 4. Factors to be considered before starting HAART: - availability, tolerability, efficacy, formulation, and side effect profile of currently available drugs, including dosage frequency, and impact on school, family, and social life - dosage in function of the farmacokinetic, complex differences in absorbtion, distribution and metabolism