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It has been well described that Greek It has been well described that Greek pediatricians often prefer to defer initiation of vaccination against hepatitis B until the second semester of life [ 12].
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Micronutrients supplementation could be a relatively low cost strategy to defer the initiation of expensive, potentially toxic and lifelong antiretroviral therapy.
However newer drugs with similar mechanisms of action could potentially be further pursued as an experimental treatment to decrease immune activation in HIV infection either as adjunct therapy to ART to decrease immune activation in treated patients or potentially to defer ART initiation.
Anti-TB drug-induced hepatotoxicity is the most common physician-determined reason to defer HAART initiation [ 34].
The following investigators, clinical centers, and committees participated in the Pediatric Randomized of Early versus Deferred Initiation in Cambodia and Thailand (PREDICT trial).
This is a sub-study in The Pediatric Randomized Early versus Deferred Initiation in Cambodia and Thailand study (The PREDICT study, clinicaltrials.gov identification number NCT00234091).
According to 2006 WHO guidelines, 14 people were eligible for early ART initiation (CD4 < 200 cells/μL or unknown), 1 for ART initiation after week 8 (CD4 200-350), and 3 for deferred ART initiation (CD4 > 350).
Clearly no medical reason exists for why deferred ART initiation should be preferred.
In patients with sputum smear-negative TB, some experts suggest deferring the initiation of therapy until results from in vitro DST become available.
Despite the advantage of pragmatic approach, deferring the initiation of treatment exposes children to a higher risk of developing severe malaria and ultimately complications and or deaths.
However, these recommendations have for the most part yet to be translated into country-level policy, and most national guidelines in developing countries continue to recommend "deferred" ART initiation at CD4 <200 cells/μL (severe immunodeficiency).
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