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Abstract:
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A variety of clinical indicators including CD4 T-lymphocyte counts, HIV viral levels,
symptoms of AIDS, and adherence to HIV drug therapies are utilized in selecting and modifying
antiretroviral (ARV) drug treatment regimens in individuals infected with HIV. Although
guidelines have been published by the National Institutes for Health (NIH) that suggest how
these indicators should be used for the treatment of pediatric HIV/AIDS, these recommendations
may overlook some of the complications associated with pediatric infection, such as poor
adherence, drug intolerance, and inadequate human growth. In order to assess the extent to
which published guidelines are used in clinical practice in hospitals located in Cape Town, South
Africa and Washington, DC, clinicians responsible for the treatment of children at these hospitals
were interviewed using original questionnaires. The results of the interviews were then
evaluated and compared to the published guidelines to determine the points of agreement and
divergence. Although the NIH recommendations suggest using CD4 counts, HIV RNA levels,
and clinical symptoms as the major determinants when prescribing drug therapy, Victoria
Hospital in Cape Town, South Africa uses adherence and general health of the child as the
primary indicators for initiation and alteration of ARV therapy. The treatment methods of
Children’s National Medical Center and Howard University Hospital in Washington, DC differ
from the published guidelines in that physicians at these hospitals place all children under the
age of one year on drug therapy regardless of any other clinical indicators. The differences that
are seen in the application of the published guidelines at these hospitals can be attributed to the
dynamics of the specific environments of Cape Town, South Africa and Washington, DC.
Because antiretroviral drugs are easily available in the United States, clinicians here are able to
treat HIV-infected children in the most aggressive ways. However, since South Africa is bound by financial limitations that limit access to ARVs, clinicians are forced to alter the published
guidelines in order to best serve their pediatric population by using primary indicators other than
those specifically recommended by the published guidelines. Thus, depending on the specific
population, clinicians of these hospitals prescribe drug therapy differently in order to meet the
needs of HIV-infected children within the confines of the specific healthcare system. |