CD4 <25%, regardless of Treat symptoms or HIV RNA level† ◯ HIV RNA ≥100,000 copies/mL ◯ HIV RNA < 100,000 copies/mL ◯ HIV RNA < 100,000 copies/mL ◯ HIV RNA < 100,000 copies/mL *CDC clinical categories C and B (except for the following category B conditions: single episode of serious bacterial infection or lymphoid interstitial pneumonitis).
†The data supporting this recommendation are stronger for those with CD4 percentage <20% than for those with CD4 percentage of 20% to 24%.
‡CDC clinical category A or N or the following category B conditions: single episode of serious bacterial infection or lymphoid interstitial pneumonitis. §Clinical and laboratory data should be re-evaluated every 3 to 4 months. ‖The data supporting this recommendation are stronger for those with CD4 count <200 than for those with CD4 counts of 200 to 350 cells/mm3.
and risks of therapy; and the ability of the caregiver to adhere to administration of the therapeutic regimen. Effective combination therapy significantly reduces viral loads and leads to the amelioration of clinical symptoms and opportunistic infections. Combination therapy that includes either a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor (PI) plus a dual–nucleoside/nucleotide reverse transcriptase inhibitor backbone is recommended for initial treatment of all HIV infected children. The goal of therapy is to reduce the plasma HIV RNA to below the level of detection and normalize or preserve the patient’s immune status. The most recent specific recommendations for treatment regimens ( http://aidsinfo.nih.gov/guidelines/ ) should be consulted before initiating therapy for any patient.
The ability of HIV to develop resistance to antiretroviral agents rapidly and the development of cross-resistance to several classes of agents simultaneously are major problems. Determination of HIV RNA, CD4 cell count, and HIV phenotype and genotype is essential for monitoring and modifying antiretroviral treatment.
Routine immunizations are recommended to prevent vaccine-preventable infections but may result in suboptimal immune responses. In addition to heptavalent pneumococcal conjugate vaccine, 23-valent pneumococcal polysaccharide vaccine is recommended for HIV-infected children at 2 years of age and adolescents and adults with CD4 counts at or above 200/mm3. Because of the risk of fatal measles in children with AIDS, children without severe immunosuppression should receive their first dose of MMR at 12 months of age and may receive the booster as soon as 4 weeks later. Varicella zoster virus (VZV) vaccine should be given only to asymptomatic, nonimmunosuppressed children beginning at 12 months of age as two doses of vaccine at least 3 months apart. Inactivated split influenza virus vaccine should be administered annually to all HIV-infected children at or after 6 months of age. HIV-infected children exposed to varicella or measles should receive varicella zoster immune globulin or immunoglobulin prophylaxis.