• Printer-friendly HIV Clinical Performance Measure: # 12

Percentage of children with HIV infection who were prescribed HAART following a diagnosis with CDC-defined AIDS

Number of clients (ages > 13 years) with AIDS (history of a CD4+ count below 200/µL or other AIDS-defining condition) who were seen within the measurement year

• CADR, Section 2, Items 26 and 31 may provide data useful in establishing a baseline for this performance measure
• Electronic Medical Record/Electronic Health Record
• CAREWare, Lab Tracker, or other electronic data base.
• HIVQUAL reports on this measure for grantee under review
• Medical record data abstraction by grantee of a sample of records that is negotiated with the OPR Review Team.
  

• • IHI Goal: 90%3
  • According to CDC Adult/Adolescent Spectrum of HIV Disease database containing records for over 60,000 persons with HIV infection, 79% of persons eligible receive antiretroviral therapy4
  • National HIVQUAL Data:5
  
  

  	2003	2004	2005
  Top 10%	100%	100%	100%
  Top 25%	100%	100%	100%
  Median*	100%	88.9%	95.7

  
  *from HAB data base

“Recommendations for when to initiate therapy have been more aggressive in children than adults because HIV infection is primarily transmitted from mother to child, thereby allowing identification of the timing of infection in children; HIV disease progression in children is more rapid than in adults; and laboratory parameters are less predictive of risk of disease progression in children, particularly for young infants…CD4 count and HIV RNA values vary considerably by age in children, and both markers are poorly predictive of disease progression and mortality in children younger than 12 months. Hence, recommendations for when to start therapy differ by age of the child.

While there is agreement among pediatric HIV experts that infected infants with clinical symptoms of HIV disease or with evidence of immune compromise should be treated, there remains controversy regarding treatment of asymptomatic infants with normal immunologic status. The Working Group recommends initiation of therapy for infants < age 12 months who have HIV-related clinical symptoms (clinical category A, B, or C) or immunologic suppression (CD4 < 25%) due to HIV disease, regardless of HIV RNA level, and consideration of therapy for HIV-infected infants < age 12 months who are asymptomatic and have normal immune parameters (Table 6). Because of the high risk of rapid progression of HIV disease, many experts would treat all HIV-infected infants < age 12 months, regardless of clinical, immunologic, or virologic parameters. Other experts would treat all infected infants< age 6 months, and use clinical and immunologic parameters and assessment of adherence issues for decisions regarding initiation of therapy in infants age 6 – 12 months. Issues associated with adherence must be fully assessed and discussed with the HIV-infected infant’s caregivers before the decision to initiate therapy is made.”

US Public Health Guidelines:
Table 6, p. 57.[1] (10/23/06)