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Signs/Symptoms
|
Management
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| Yellow eyes (jaundice) or abdominal pain |
- Stop medicines and refer urgently
|
| Rash |
- If on abacavir, assess carefully. Are there any signs & symptoms of Abacavir hypersensitivity: Is there any fever, nausea, vomiting, diarrhoea or abdominal pain? Is there generalized fatigue or achiness? Is there any shortness of breath, cough or pharyngitis? If the child has at least 2 of the above, do NOT stop medicine but call for advice or refer urgently
- If on efavirenz or nevirapine:
- If the rash is severe and associated with symptoms such as fever, vomiting, oral lesions, blistering, facial swelling, conjunctivitis and skin peeling, STOP all medicines and refer urgently
- If the rash is mild to moderate, with no systemic symptoms; the medicine can be continued with no interruption but under close observation
|
| Nausea and vomiting |
- Advise that the medicines should be given with food. If persists for more than 2 weeks or worsens, call for advice or refer. If vomiting everything, or vomiting associated with severe abdominal pain or difficult breathing, refer urgently
|
| Diarrhoea |
- Assess, classify and treat using diarrhoea charts. Reassure caregiver that if due to ARV, it will improve in a few weeks. Follow-up as per Chart Booklet. If not improved after two weeks, call for advice or refer
|
| Fever |
- Assess, classify and manage according to Fever Chart
|
| Headache |
- Give paracetamol. If on efavirenz, reassure that this is common and usually self-limiting. If persists for more than 2 weeks or worsens, call for advice or refer
|
| Sleep disturbances, nightmares, anxiety |
- This may be due to efavirenz. Give at night; counsel and support (usually lasts less than 3 weeks). If persists for more than 2 weeks or worsens, call for advice or refer
|
| Tingling, numb or painful feet/legs |
- If new or worse on treatment, call for advice or refer
|
| Changes in fat distribution |
- Ask about and look for changes in appearance, especially thinness around the face and temples and excess fat around the tummy and shoulders
- If child on stavudine: Substitute stavudine with abacavir if VL is less than 50 copies/mL. If VL is greater than 50 copies/mL or if the child is not on stavudine, refer
- If child develops enlarged breasts (lipomastia) which is severe and/or occurs before puberty, refer
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