Because of the differences in CD4 count and percentage and prognosis between children and adults, Recommendation 1 needs to be modified for children, but still easily abstracted from the medical record. Count, percentage, or both may be available in medical records, but recent studies indicate that CD4 percentage adds little to the prognostic value of CD4 count. Based on approximate equivalency for the various age groups for HIV disease progression and death, the committee suggests the age-specific CD4 count and percentage criteria for children shown in Table S-1.
The conditions listed in Recommendation 2 are also rare in children but have been reported. Accordingly, a similar listing should be included in the pediatric HIV Infection Listing. Modifications should include the replacement of HIV-associated dementia with the current listing for neurological manifestations of HIV infection (currently 114.08G). Even in the era of combination antiretroviral therapy, neurological manifestations still present serious challenges for children. Therefore, neurological manifestations in children and adolescents should be maintained under Part B. In addition, growth development is an important indicator of their health and is seen as one of the most sensitive indicators of disease progression. Growth disturbance or failure to grow has been associated with rapid progression from asymptomatic HIV infection to AIDS in children thus leading to shorter survival. As a result, the committee concluded that the current listing for growth disturbance (currently 114.08H) should be retained in Part B.
In Part B, the measures of functioning used in Recommendation 4 should reflect measures relevant to children—developmental and emotional disorders of newborn and younger infants (currently paragraphs A–E of 112.12) and organic mental disorders (currently paragraphs B1–B2 of 112.02).
Although the conditions contained in Recommendation 5 are not common in children, they do occur and may become more evident as perinatally infected children continue to age. Additionally, there are current pediatric listings for these conditions that would be applicable. Therefore, the com-