Spectrum: Local Antimicrobial Stewardship, for Yangon Children's Hospital

Treatment Failure

WHO Definitions of Clinical, Immunological, and Virological Failure for the Decision to Switch ART Regimens

Clinical Failure

Adolescents: New or recurrent clinical event indicating severe immunodeficiency (WHO clinical stage 4 condition) after 6 months of effective treatments

Children: New or recurrent clinical event indicating advanced of severe immunodeficiency (WHO clinical stage 3 and 4 clinical condition with the exception of TB) after 6 months of effective treatment

Immunological Failure

Adolescents: CD4 count ≤250 cells/mm³ following clinical failure or persistent CD4 level <100 cells/mm³

Children:

  • Younger than 5 years: Persistent CD4 levels <200 cells/mm³

  • Older than 5 years: Persistent CD4 level <100 cells/mm³

Virological Failure

Viral load >1000 copies/mL based on two consecutive viral load measurements within 2-3 months, with adherence support following the first viral load test