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Question :

Posted On : 24 Jan 2007

I have a child who is a known case of hiv plus ve since two years and is on septran prophylaxis. She is put on 3 drug ART since 6 months {lamuvudine ,zido, nevirapine}. She presented with pancytopenia and low retic counts suggesting bone marrow supression. Please tell me what shall I do next about the ART and how do I treat other than giving a transfusion for the anemia. What is the role of G- CSF in these children? Her cd4 counts are very low and her age is 6 yrs.

Expert Answer :

No expert answer available.

Answer Discussion :

pediatriconcall

One should rule out anemia due to drugs, opportunistic infections and due to HIV virus itself. You need to stop the septran and shift her to dapsone. Again zidovudine may need to be omitted as it is known to cause bone marrow suppression. Since the child is on 3 drug ART since 6 months and still has a low CD4 count, one needs to find out whether the child is drug resistant. In such a case shifting to a PI based regime along with abacavir and lamivudine-ddI would be useful. Rule out other OIs such as hepatitis B and Hepatitis C, CMV infection and mycobacterium infection {all of which can cause bone marrow suppression }.
G-CSF has been tried in few patients with neutropenia with limited success.

18 years ago

DR.RAJESH SHAH

i suggest to give venofer infusion
instead of blood transfusion.omitt
zidovidine and shift to stavudine based
regimen.no role of g-csf in your child.

18 years ago

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