Comparison of Drug Treatment Protocols for Children Infected with HIV in Washington, DC and Cape Town, South Africa in Relation to NIH Guidelines

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