HI! I am looking into children whose mothers went through PMTCT and they themselves also received prophylaxis but still tested positive using PCR testing. It seems all parameters are indispensable. Please which parameters are key when considering quality of care.
Hello,
I think u need to first revisit the ANC/PMTCT records of their mothers to reevaluate the quality of care (esp mothers' ARV adherence). Next is to investigate for, or rule out the possibility of HIV Drug resistance in both mother/baby pairs, and then also consider infant feeding patterns especially if the infants are being breastfed and the mothers are not yet placed on ARV therapy while still breastfeeding. If HIV Drug resistance is found an a switch to an appropriate regimen should be
Whatever the findings from the further evaluation, the monitoring parameters are still the same: clinical response to on going regimen (ARV therapy) anthropometric & growth indices, CD4+ versus VL responses and other haematological parameters at subsequent follow up visits. This is assuming that othwr important factors, such as nutritional support and prophylaxis for OIs are guaranteed.
Clinically anthropometric measures which include height,weight ,Mid-upper arm circumference
And Laboratory wise,Viral load and CD4%
I am a HIV researcher, not a clinician, but I would think that viral load in the mother, and drug resistance testing of the mother's and infant's virus would be wise. If the virus was transmitted because it is resistant to one or more of the drugs being used a change in therapy for both mother and infant may be needed.
Allparameters related to good adherence to drugs from the mothers are important to be looked to; more importantly the viral load which can tell us about possible resistance is a key for decision and further investigations.
Hello,
I think u need to first revisit the ANC/PMTCT records of their mothers to reevaluate the quality of care (esp mothers' ARV adherence). Next is to investigate for, or rule out the possibility of HIV Drug resistance in both mother/baby pairs, and then also consider infant feeding patterns especially if the infants are being breastfed and the mothers are not yet placed on ARV therapy while still breastfeeding. If HIV Drug resistance is found an a switch to an appropriate regimen should be
Whatever the findings from the further evaluation, the monitoring parameters are still the same: clinical response to on going regimen (ARV therapy) anthropometric & growth indices, CD4+ versus VL responses and other haematological parameters at subsequent follow up visits. This is assuming that othwr important factors, such as nutritional support and prophylaxis for OIs are guaranteed.
Despite PMTCT, a baby may be HIV infected. May be due to HIV Drug resistance, ineffective ART etc.
In this case, appropriate ART has to be initiated immediately for infected child.
For more effective PMTCT, the moment the mother is detected HIV positive, ART has to be initiated and continued thereafter.
The revised classification system for human immunodeficiency virus (HIV) infection in children replaces the pediatric HIV classification system published in 1987 (1). This revision was prompted by additional knowledge about the progression of HIV disease among children. In the new system, infected children are classified into mutually exclusive categories according to three parameters: a) infection status, b) clinical status, and c) immunologie status. The revised classification system reflects the stage of the child's disease, establishes mutually exclusive classification categories, and balances simplicity and medical accuracy in the classification process.
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