Dieu tri ARV o tre em

10.1. Chi dinh dieu tri:

Dieu tri ARV cho tre nhiem HIV duoc chi dinh tren co so giai doan lam sang cua tre (phu luc 2: Phanloai giai doan lam sang HIV/AIDS o tre em), ty le TCD4 hoac tong so te bao lympho, va kha nang thuc hien duoc xet nghiem khang dinh tinh trang nhiem HIV o tre.

Bang 11: Chi dinh dieu tri ARV cho tre nhiem HIV

 

































Tre < 18 thang tuoi
Co xet nghiem virus hoc
Co xet nghiem TCD4
- Giai doan IV (AIDS) khong phu thuoc ty le TCD4

- Giai doan I, II hoac III, va ty le TCD4 < 20%

Khong co xet nghiem TCD4
- Giai doan IV (AIDS)

- Xem xet dieu tri cho tat ca benh nhi o giai doan III

- Xem xet dieu tri cho benh nhi o giai doan II neu tong so te bao lympho < 2500/mm3

Khong co xet nghiem virus hoc *
Co xet nghiem TCD4
- Giai doan IV (AIDS), khong phu thuoc ty le TCD4

- Xem xet dieu tri cho tat ca benh nhi o giai doan  III

- Chi dieu tri cho benh nhi o giai doan I hoac II khi ty le TCD4 < 20%

Khong co xet nghiem TCD4
- Chi dieu tri khi benh nhi o giai doan IV

Tre > 18 thang tuoi
Co xet nghiem TCD4
- Giai doan IV (AIDS) khong phu thuoc ty le TCD4

- Xem xet dieu tri cho tat ca benh nhi o giai doan lam sang III

- Giai doan II hoac II, va ty le TCD4 < 15%

Khong co xet nghiem TCD4
- Giai doan IV (AIDS) khong phu thuoc ty le TCD

- Xem xet dieu tri cho tat ca benh nhi o giai doan III

- Xem xet dieu tri cho benh nhi o giai doan II neu tong so te bao lympho < 1500/mm3


 

 

* Lam lai xet nghiem khang the HIV khi tre ≥ 18 thang tuoi va da ngung bu me hoan toan 6 tuan

10.2. Phac do dieu tri ARV hang dau cho tre em

- Phac do ­u tien:                  d4T +  3TC +  NVP

- Cac phac do thay the:       d4T +  3TC +  EFV; hoac

ZDV +  3TC +  NVP; hoac

ZDV +  3TC +  EFV

(Lieu luong va cach dung xem Phu luc 7: Cac thuoc ARV cho tre em).

- Luu y:

+ Su tuan thu dieu tri o tre em thuong rat kho khan nen cha me hoac nguoi cham soc tre can duoc tu van ky luong ve su tuan thu dieu tri.

+ Thuoc dung theo can nang va lieu can duoc dieu chinh khi tre lon len. (Xem Phu luc 8: Cac thuoc ARV cho tre em).

+ Da so thuoc ARV dung cho nguoi lon co the su dung cho tre em. Neu su dung dang thuoc nguoi lon cho tre, can chu y khi chia nho vien thuoc (nen dung dao cat) de khong bi qua lieu (gay ngo doc) hoac thieu lieu (gay khang thuoc). (Xem Phu luc 8: Cac thuoc ARV cho tre em).

+ Khong dung EFV cho tre duoi 3 tuoi hoac tre nang d­oi 10 kg.

+ Nen dung phac do co EFV cho tre tren 3 tuoi dang dieu tri lao bang Rifamycin.

+ Doi voi tre duoi 3 tuoi nhiem HIV va dang dieu tri lao bang rifamycin: Lua chon  phac do AZT + 3TC +  ABC, lieu luong va cach dung xem Phu luc 8: Cac thuoc ARV cho tre em.

10.3. Theo doi dieu tri

Lam sang: Tre duoc dieu tri ARV can duoc heo doi ve can nang, tan suat cac nhiem trung co hoi... nhu doi voi nguoi lon. Ngoai ra can chu y mot so diem sau:

- Danh gia dinh duong va tinh trang dinh duong.

- Phat trien the luc (chieu cao va can nang theo lua tuoi).

- Phat trien tinh than va van dong theo lua tuoi.

- Phat trien nhan thuc va hieu biet xa hoi.

- Theo doi chat che cac bieu hien ve doc tinh cua thuoc

Xet nghiem: Cac xet nghiem co ban nhu doi voi nguoi lon, luu y ty le TCD4.

Bang 10: Cac dau hieu danh gia that bai dieu tri













Cac dau hieu lam sang
Xet nghiem

- Ngung tang hoac sut can o nhung tre luc dau da co tang can

- Khong co cac dau hieu cai thien ve tinh than hoac xuat hien cac benh ly moi ve nao.

- Xuat hien cac nhiem trung co hoi moi hoac khoi u, chi diem su tien trien cua nhiem HIV.

- Cac nhiem trung co hoi tai phat
- So luong tuyet doi hoac ty le TCD4 khong tang hoac giam so voi luc bat dau dieu tri

- So luong TCD4 tro lai muc do nhu truoc khi dieu tri hoac thap hon so luong truoc dieu tri ma khong thay can nguyen nhan nao khac.

- So luong (hoac ty le) TCD4 giam tren 50% so voi so luong toi da dat duoc ke tu khi bat dau dieu tri ma khong thay co can nguyen nao khac.


 

10.4. Cac phac do dieu tri ARV hang thu  2 cho tre em

Chi dinh khi phac do dieu tri hang thu nhat that bai.

 








ABC +  ddI +  LVP/r hoac NFV


 

 

(Lieu luong va cach dung xem Phu luc 8: Cac thuoc ARV cho tre em).

11. Dieu tri ARV o phu nu co thai

Nhung phu nu co thai co du cac tieu chuan dieu tri nhu cac benh nhan nguoi lon nhiem HIV can duoc dieu tri ARV (Xem phan tieu chuan dieu tri ARV cho nguoi lon).

- Phu nu mang thai nhiem HIV chua dieu tri ARV truoc do: Khong bat dau dieu tri ARV trong 12 tuan dau cua thai ky de giam nguy co doc tinh cua thuoc ARV voi thai nhi.

- Phu nu nhiem HIV dang dieu tri ARV phat hien co thai: Tiep tuc dung ARV nhung khong dung Efavirenz trong 3 thang dau.

Cac phac do:

- Phac do uu tien:      ZDV + 3TC + NVP

Lieu dung: nhu cho nguoi lon

- Phac do thay the:    ZDV  +  3TC  + NFV hoac

ZDV  +  3TC  +  SQV/r hoac LPV/r

Lieu dung:        + Nelfinavir 1250mg uong 2 lan/ngay

+ Saquinavir/ritonavir uong 1000 mg/100 mg 2 lan/ngay

+ Lopinavir/ritonavir uong 400mg/100mg 2 lan/ngay

Luu y:               + Theo doi chat che cac tac dung phu.

+ Khong dung phoi hop ddI va d4T cho phu nu co thai vi lam tang nguy co toan lactic va doc voi gan.

+ Khong dung ZDV cung voi d4T.