I am a paediatrician in Uganda 3rd world setting I have a child I am attending too whose CD4 count has failed to pick up despite ART with good adherence she has clinically responded to the ARVs. What to do

A Day 15 old girl born to HIV infected parents came for first follow up visit. Mother was diagnosed to be HIV infected at 6 moths of gestation and had received Zidovudine for 3 months. Baby was born vaginally and not on breast feeds. Birth weight of the child was 3 kg. Baby was started on Zidovudine 2 mgkg dose 6 hoy and was advised to give 0.6 ml qds of Zidovudine syrup 5 ml = 50 mg every 6 hoy. However, on interviewing the mother, it was found that she was giving the baby 6 ml 6 hoy instead of 0.6 ml 6 hoy. However, the baby had no other symptoms. On examination, her weight was 3.5 kg and examination findings were normal.

WIth the advent of FDCs and free ART, antritretroviral therapy has become affordable and convenient for children. However most of the pediatric FDCs are avaibale with NVp and EFV is mainly kept aside to be used in children on ART with TB coinfection. But there is a problem there. There are some instances when patients who have been on EFV based therapy for years when go to the government centre are shifted to NVP as the govt plan has no provision for EFV in these children. Also if a child is on anti TB treatment ATT and he is started on ART then he is given EFV for the time that he is on ATT and then shifted to NVP once ATT is stopped. Also there is no govt provision for children less than 3 years and when requiring ART with ATT.. When will this interchangibility end Logistically it may be a lot of money but resistance is a major issue. The rules need to be more open to EFV based regime in these children or allow NVP to be increased to a dose of 400mgsqmday when the child is on ATT.