On ARV treatment for children Living with HIV

[Guest guest]

Dear Romaji,

Thanks for your frank posting and sharing the experiences you had with

doctors/hospitals.

Without seeing your daughter and going thro' relevant report, I can not

opine, if she should be on Anti-retroviral Therapy or not. There can not be

a rule of thumb on if somebody can be without ART for' X' number of years

and hence, I wouldn't agree with what Ashok Rau said you that you should

allow her to live without medicine as long as she can live without medicine

and then start when she can not live without medicine. There may be some

communication gap, as I do not think somebody can advise like this.

It is true that person with HIV can live without ART (not totally without

medicine, he/she may need anti-TBV, vitamines, PCP prevention, de-worm,

anti-amoeabic etc), for 5-10 years after infection with HIV. But the pt. or

their relative can not make out when the person could have been infected and

an expert has to make a proper work-up and analyses based on history of the

pt., clinical examinations and laboratory tests (based on affordability,

offcourse).

Ideally ART is prescribed based on following principals:

Asymptomatic patients do not need ART, this phase may be from 5-10 years

ART is to be prescribed when the patient has OI or is likely to develop them

soon

When Absolute CD4 count is < 200 cells/ml

When the Plasma Viral Load is > 100,000 copies/ml (if affordable)

According to WHO: In resource-limited settings, HIV-infected adults should start

ART when they have:

WHO stage IV of HIV disease (clinical AIDS), regardless of the CD4 count;

WHO stages I, II or III of HIV disease, with a CD4 count below 200/mm3;

WHO stages II or III of HIV disease with TLC below 1200/mm3.

I do not wish to give you and confuse with much of technical details, but

definitely advise you to consult a rationale HIV expert and decide on ART.

However, if she is already on ART for a long time then you should not stop

it, even if it was started wrongly in the first place.

You can do proper planning and treat her with low cost, save for

contingency, in case you are no more there.

There are no programs in India, to my knowledge, that supports ART, but one

can always try on case to case basis and there are some philanthropists who

do help.

Dr.I.S.Gilada

UNISON MEDICARE & RESEARCH CENTRE

Maharukh Mansion, Alibhai Premji Marg, Grant Road (East); Mumbai-400007

Tel.: 23061616 (Clinic); Fax: 23000016; E-mail:gilada@...