HANDOUT ON HIV AIDS IN NEONATOLOGY

Presented by – Athira Uthaman

INTRODUCTION
In India, the prevention of parent-to-child transmission and antiretroviral
therapy services for HIV-infected mothers and children have been rapidly
scaled up over the recent years. Despite these advances, a large number of
HIV-infected children are born in every year. A thorough literature review has
been done by extracting recent findings from the official websites of the
National AIDS Control Organization, UNAIDS, UNICEF, and World Health
Organization. The efforts that are made to control pediatric HIV are challenged
by a large range of factors such as low health service utilization, poor drug
adherence, delayed infant diagnosis, discriminatory attitude of health
providers, loss to follow-up, and poor coordination in managing continuum of
care. These challenges may be addressed by adopting innovative and effective
strategies and strengthening the existing health system. This would bring
about a significant reduction in pediatric HIV incidence and improve the
outcomes in children who are HIV infected. (according to Indian Journal of
Public Health).

DEFINITION OF HIV/AIDS.
The HUMAN IMMUNODEFICIENCY VIRUS (HIV) targets cells of the immune system, called
CD4 cells, which help the body respond to infection. Within the CD4 cell, HIV replicates and
in turn, damages and destroys the cell. Without effective treatment of a combination of
antiretroviral (ARV) drugs, the immune system will become weakened to the point that it
can no longer fight infection and disease.

ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) is a term that applies to the most

advanced stages of HIV infection. It is defined by the occurrence of any of the more than 20
life-threatening cancers or “opportunistic infections”, so named because they take
advantage of a weakened immune system. AIDS was a defining feature of the earlier years
of the HIV epidemic, before antiretroviral therapy (ART) became available. Now, as more
and more people access ART, most people living with HIV do not progress to AIDS. However,
it is more likely to occur in people with HIV who have not been tested, in people who are
diagnosed at a late stage of infection, and in people who are not taking ART.

INCIDENCE OF HIV/AIDS IN NEAONATES

ACCORDING TO INDIA HIV ESTIMATES REPORT 2019 - Nationally, HIV incidence was
estimated at 0.05 per 1,000 uninfected population in 2019. It has declined from 0.54 in 1995
to 0.05 in 2019.State/UT-wise, incidence per 1,000 uninfected population was estimated to
be the highest in the three north-eastern States of Mizoram (1.18 per 1,000 uninfected
population), Nagaland (0.73) and Manipur
(0.34) in 2019. Other States estimated to have HIV incidence per 1,000
uninfected population above the national average of 0.05 were Meghalaya (0.23), Delhi
(0.15), Tripura (0.11), Chhattisgarh (0.10), Haryana (0.09), Punjab (0.08), Telangana (0.08),
Bihar (0.07) and Maharashtra (0.07).
ACCORDING TO WHO
Children living with HIV continue to be left behind by the global AIDS response. In 2019, only
53% (950 000) of the 1.8 million children living with HIV (aged 0–14 years) globally were
diagnosed and on treatment, compared to 68% of adults. The remaining 850 000 children
living with HIV have not been diagnosed and are not receiving life-saving HIV treatment.
Two thirds of the missing children are aged 5–14 years and do not routinely attend
traditional health facilities. Engaging communities and the families of people living with HIV,
tuberculosis and other related diseases and offering family services are needed in order to
find and start on treatment those missing children.
An estimated 95 000 children died of AIDS-related illnesses in 2019, in part due to lack of
early diagnosis of HIV among infants and children and immediate linkage to optimal HIV
treatment regimens. Untreated, 50% of infants infected with HIV during or around the time
of birth will die before the age of two years.

MODE OF TRANSMISSION
90 percent of the children living with HIV are infected through mother-to-child transmission during
pregnancy, around the time of birth or through breast feeding.

With the rapid and significant expansion in the National AIDS Control Program including. the PPTCT,
ICTC, ART (for adults and children) programs, including access to early diagnosis for HIV testing of
infants and children below 18 months of age, it is now possible to ensure that HIV exposed and
infected infants and children receive the required essential package of care.

CLASSIFICATION SYSTEM OF HIV DISEASE IN CHILDREN

HIV INFECTED

A child less than 18 months of age who is HIV sero-positive or born to HIV infected mother and has
positive results on two separate determinations from one or more of the following tests:

 HIV culture
 PCR test
 HIV antigen (P24)
 Or meets clinical criteria for AIDS diagnosis

A child 18 months of age or older born to HIV infected mother or infected by blood, blood products
or other known modes of transmission, who is HIV-Antibody positive by being repeatedly reactive in
ELISA and confirmatory test positive (e.g.: Western blot) or meets any of the criteria as above is
labelled as HIV infected.
 PERINATALLY EXPOSED

A child who does not meet the criteria above, but who is HIV sero positive by ELISA and confirmatory
test and is less than 18 months of age at the time of the test or has unknown antibody status but
was born to a mother known to be infected with HIV.

SERO-REVERTER

A child who is born to HIV infected mother and who has been documented as HIV antibody negative
(i.e. 2 or more negative ELISA tests performed at 6-18 months of age or 1 negative ELISA test after 18
months of age) and has had no other laboratory evidence of infection and no AIDS defining
condition.
CLINICAL MANIFESTATIONS
Clinical assessments are important in the care of infants and children – clinical findings can indicate
HIV infection, and where available, additional laboratory tests may be done to confirm suspicion for
opportunistic infections.

The clinical manifestation of HIV infection varies widely among infants, children and adolescence. In
most infants, physical examination at birth is normal, initial symptoms may be subtle, such as
lymphadenopathy and hepatosplenomegaly or non-specific such as failure to thrive, chronic or
recurrent diarrhea, interstitial pneumonia or oral thrush may be distinguishable only by their
persistence. Whereas systemic and pulmonary findings are common in USA and Europe.

The HIV classification system is used to categorize the stage of pediatric disease by using two
parameters:

 Clinical status
 Degree of immunological impairment

Category A – Mild Symptoms

This includes children with at least two mild symptoms such as lymphadenopathy, parotitis,
hepatomegaly, splenomegaly, dermatitis and reoccurrence or persistent sinusitis or otitis media.

Category B – Moderate Symptoms

This includes children with LIP, oropharyngeal thrush persisting for more than 2 months, recurrent or
chronic diarrhea, persistent fever for more than 1 month, hepatitis, recurrent HSV, stomatitis or HSV
esophagitis or pneumonitis and disseminated varicella, cardiomegaly or nephropathy.

Category C – Severe Symptoms

This includes for example children with 2 serious bacterial infections (sepsis, meningitis, pneumonia)
in a 2 year period, esophageal or lower respiratory tract candidiasis.

DIAGNOSIS
Pediatric AIDS differs from the infection in adults in the sense, that children are innocent
victims of AIDS mainly through vertical transmission. In these cases, mothers and/or other
members of the family are invariably infected with HIV and may also be having clinical AIDS.
The diagnosis is difficult to establish before the month of 18 months. But with the advanced
technology, we are now able to screen HIV at the earliest.
ACCORDING TO WHO GUIDELINES

 Because of the high risk of death before the age of 2 years among HIV-infected
infants, and given the increasing availability of paediatric antiretroviral treatment in
many resource-limited settings, WHO recommends that national programmes should
establish the capacity to provide early virological testing of infants for HIV.
 Assays and diagnostic platforms that should be considered by health ministry
programmes for early infant HIV diagnosis include externally validated tests for HIV
DNA or HIV RNA (including polymerase chain reaction, PCR) which are commercially
and non-commercially available.
 Serological assays suitable for HIV antibody detection in adults cannot be reliably
used for confirmatory diagnosis of HIV in infants as the interpretation of positive HIV
antibody testing is complicated by the fact that maternal HIV antibody can persist for
18 months (although it usually clears by 9−12 months).

EARLY VIROLOGICAL DIAGNOSIS OF HIV INFECTION IN INFANTS AND CHILDREN

1. Enables the early identification of who have HIV-infection, as a first step in securing
their treatment and care.
2. Enables the identification of those who are HIV-exposed but uninfected, facilitating
follow-up care and prevention measures that will help to ensure that they remain
uninfected.
3. Assists in the effective use of essential resources by targeting ART on children who
need treatment.
4. improves the psychosocial well-being of families and children, reducing potential
stigma, discrimination and psychological distress for HIV-uninfected children and
increasing the chances of adoption for orphans.
5. Facilitates life-planning for parents and/or children who have HIV.

WHY EARLY DIAGNOSIS IS CRUCIAL?

Early diagnosis of HIV allows health-care providers to offer optimal care and treatment of
HIV infected children, assists in decision-making on infant feeding, and avoids needless
stress in mothers and families. The increasing efficacy and coverage of PMTCT interventions
mean that the majority of children born to HIV-infected mothers will be uninfected (with
effective ARV/ART interventions exceeding 90%). Consequently, recognizing those with
infection before they become unwell is only possible through routine diagnostic testing,
ideally in services for PMTCT or maternal and child health. WHO recommends that this be
performed with virological testing at the age of 6 weeks or any time subsequently, initiated
by the responsible health care providers as outlined in WHO guidance on provider initiated
HIV testing.
If there are no interventions, about 5−20% of infants of HIV-positive mothers become
infected through breastfeeding. There is evidence that exclusive breastfeeding in the first
months of life is safer than mixed feeding. If mothers are on ART for their own health,
transmission through pregnancy and breastfeeding is likely to be reduced. Early diagnosis
also assists in decision-making on breastfeeding. An HIV-positive mother with an HIV-
uninfected baby can be counselled and supported to stop breastfeeding if replacement
feeding is acceptable, feasible, affordable, sustainable and safe (AFASS). If the baby is HIV-
infected the mother can be counselled and supported to continue breastfeeding. Finally,
early diagnosis of HIV in infants assists families in life-planning.
Polymerase chain reaction and other nucleic acid detection technologies
Ultrasensitive p24 antigen assay

ACCORDING TO PPTCT
Prevention of Parent-to-Child Transmission of HIV
Confirmation of HIV Status in HIV Exposed Infants should be done at 18
Months, Regardless of Earlier Diagnosis
All HIV exposed infants and children regardless of HIV status will be followed-up until 18 months of
age for care, monitoring and the final confirmatory HIV test at 18 months using 3 HIV Rapid tests
(even if HIV-1 rapid test is negative).

If any HIV exposed infant or child develops clinical signs and symptoms suggestive of HIV infection,
the Medical Officer at the health care facility should start immediate treatment for the acute illness,
stabilise and refer urgently to ART Centre. HIV testing according to the national testing algorithm for
infants and children above 18 years should also be done.

Follow-up of HIV infected infants and children started on ART shall be done by ART centres in
collaboration with the Paediatrician at the institution where ART Centre is located. Infants and
children on ART must undergo the confirmatory three antibody tests at 18-months of age in the
nearest ICTC, irrespective of the results of the first rapid antibody test.

EARLY INFANT DIAGNOSIS (EID) OF HIV INFECTION PROGRAMME

Globally, the World Health Organisation (WHO) has recommended the implementation of Early
Infant Diagnosis (EID) and treatment among HIV exposed infants to achieve the 2030 goal of HIV
elimination. The EID programme is aimed at early HIV diagnosis and subsequent initiation of Anti-
Retroviral Treatment (ART); consequently, DNA Polymerase Chain Reaction (PCR) tests are
conducted at 6 weeks of age and onwards.

 HIV-infected babies are the most vulnerable of all patients with ~ mortality > 50% by
age 2 in untreated patients.
 These patients would benefit the most from ART, but diagnosis is difficult due to the
presence of maternal HIV antibodies transferred from mother to child during
pregnancy, childbirth and breastfeeding.
  Most infants born to HIV+ mothers would test positive using standard HIV antibody
tests such as ELISA or rapid tests until the level of maternal antibody falls below limit
of detection at 18 months.
 Thus, in infants below 18 months of age, direct detection tests for the virus have to
be conducted, and the current test of choice is the HIV-1 PCR which detects HIV pro-
viral DNA & RNA.

EARLY INFANT DIAGNOSIS

Maternal HIV antibody transferred passively during pregnancy can persist for as long as 18 months
in children born to HIV-infected mothers. Hence, positive HIV antibody test does not necessarily
indicate HIV infection in the infant/child. In children who are breastfed, since they have ongoing
risk for HIV transmission, HIV infection can only be excluded after 6 weeks of complete cessation
of breastfeeding. In the current Early Infant Diagnosis (EID) program, virological tests i.e. HIV-1
DNA PCR by Dried Blood Spot (DBS) and on Whole Blood Sample (WBS) are being done for infants
and children below 18 months of age, as per the algorithm . Antibody tests, using rapid test
method can be used for children > 18 months of age for diagnosis of HIV infection as in adults.
Dried Blood Spots (DBS)/ Plasma are the specimens that can be used to perform HIV-1 PCR testing.

Algorithm for diagnosis of HIV infection at < 6 months of age

 At ICTC level: Collect & send Dried Blood Spot (DBS) of babies between 6 weeks to < 6
months of age for HIV-1 PCR test to the PCR testing laboratory.
 HIV-1 Detected: Infant is probably HIV-1 infected. Lab will ask for another DBS sample.
• If repeat sample is positive then baby is infected. Refer baby to ARTC for treatment.
• If repeat sample is negative, then the lab will ask for another DBS sample and will rely on
the result of this sample for establishing diagnosis.
 HIV-1 Not Detected: Ask baby to visit at 6 months age for testing again or if the baby
develops signs and symptoms of HIV (whichever is earlier).

NOTE –

 Rapid antibody test is not recommended

 If baby is < 6 weeks old then PCR test is not recommended; 6 weeks and above is the optimal
age for a routine first PCR test –
 If a DBS tests positive then another sample collected at a different time (not two samples
spotted at same time) should be sent for confirming diagnosis.

Algorithm for diagnosis of HIV infection at 6-18 months of age

 At ICTC level: Collect blood and test for HIV antibodies using all three serological tests. Also
prepare a Dried blood spot (DBS) for HIV-1 PCR test simultaneously.
 If all three or any 2 or any one serological test is positive – Send Dried Blood Spot (DBS) of
child for HIV-1 PCR test and follow the EID testing algorithm.
 If all three rapid serological tests are negative – Baby does not need HIV-1 PCR test at this
point – Ask baby to come back for testing at 6 weeks after last breast milk feeding OR at 12
months OR if baby develops symptoms of HIV infection, whichever is earlier

CARE OF EXPOSED INFANT/CHILD

HIV disease progresses very rapidly in most young children, especially in the first few months of life,
often leading to death. HIV infected infants frequently present with clinical symptoms in the first
year of life. Without care and treatment, about one third of infants living with HIV will die in their
first year of life and almost half of the children with HIV will die the second year of life.

Infant and child born to HIV infected woman, are reliably excluded or confirmed with HIV status and
the infant or child is no longer exposed to HIV through breast feeding.

Components of Care-
Immediate Care at Birth
Infant feeding
ARV prophylaxis
Cotrimoxazole prophylaxis (CPT)
Immunization and Vitamin A Supplementation
Growth and Development
Early infant diagnosis
Follow up

Immediate Care at Birth

The immediate care of the newborn infant at birth should follow standard neonatal care guidelines
including resuscitation guidelines.

However, the following should be adhered to:

Follow universal precautions.
Do not milk the cord.
The cord should be clamped soon after birth.
Cover the cord with gloved hand and gauze before cutting to avoid blood splattering.
Initiate breast feeding within the first hour of birth in accordance with the preferred and informed
choice of the mother

ART DRUGS
Antiretroviral comprise three main classes of drugs:
 ARV PROPHYLAXIS FOR INFANTS BORN TO MOTHERS RECEIVING LIFE-LONG ART
Infant ARV prophylaxis is required for all infants born to HIV infected women receiving ART to
further reduce pre-partum and postpartum HIV transmission, in addition to the protection received
from the mother’s ART regimen. Infant ARV prophylaxis provides added protection from early
postpartum transmission, particularly in situations where women started ART late in pregnancy,
have less than optimal adherence to ART and have not achieved full HIV viral suppression.

ARV prophylaxis to the infant must be given in accordance with the current National PPTCT
Guidelines. For all the exposed infants, Syp. NVP has to be given for 6 weeks and these children
have to be linked to the EID programme. The ART provision shall depend on the result of EID.

All Infants born to women who are receiving ART / maternal triple ARV prophylaxis / who present
directly-in-labor and receive intra partum ARV prophylaxis should be started on daily NVP
prophylaxis at birth and continue for a minimum of 6 weeks (i.e., till the first immunization visit
for the infant). This regardless of whether the infant is exclusively breastfed or receives
replacement feeding it helps in reducing the risk of postpartum HIV transmission.

Dose and Duration of Infant Daily NVP Prophylaxis

 ARV PROPHYLAXIS FOR INFANTS BORN TO WOMEN PRESENTING IN ACTIVE LABOUR
All infants born to women who present directly-in-labour and receiving intra partum ART and
regularly thereafter, should be started on daily NVP prophylaxis at birth and continued for a
minimum of 6 weeks. These needs to be extended to 12 weeks as mother has not received adequate
duration of ART to suppress viral replication. However, EID should be carried out at 6 weeks as per
guidelines.

In situations, where infants born to women who present directly-in-labor and receive intra partum
ARV prophylaxis, the daily NVP prophylaxis for the infant should not be stopped at 6 weeks of life.
These infants should be continued on NVP prophylaxis until the mother initiated on ART/ARV
prophylaxis and complete a minimum of six weeks of therapy.

ARV PROPHYLAXIS FOR INFANTS BORN TO WOMEN WHO DID NOT RECEIVE ANY ART
(HOME DELIVERY)
In case of infants who are born to HIV infected mothers who did not receive any antenatal or pre-
partum ART, or in cases where maternal HIV infection is detected after the birth of the infant (home
delivery):

 Infants should be started on daily Sy NVP prophylaxis at their first contact with health
services.
 Daily infant NVP prophylaxis can be started even if more than 72 hours have passed since
birth.
 Daily infant NVP prophylaxis should continue for atleast 12 weeks, by which time the mother
should be linked to appropriate ART services.

ARV PROPHYLAXIS FOR INFANTS BORN TO WOMEN WITH HIV II INFECTION

Prophylaxis NVP with AZT (instead of Syp NVP) to be given to babies in mothers with HIV -2

Choice of a first-line regimen for infants and children < 24 mths

No exposure to NNRTIs

Standard Nevirapine-containing triple therapy is the preferred option when choosing a first-line
regimen for infants and children (< 24 months) without exposure to maternal or infant NNRTIs, or
whose exposure to maternal or infant NNRTI is not known.

Standard Nevirapine-containing Regimen

2 NRTIs + NVP

With exposure to Nevirapine

HIV-infected infants and children < 24 months exposed to nevirapine through infant prophylaxis,
maternal treatment, or prophylaxis exhibit viral resistance and their response to nevirapine-
containing first line treatment regimens may be compromised.

Therefore, HIV-infected infants and children with a history of exposure to single dose nevirapine or
NNRTI-containing maternal ART or preventive ARV regimens, should start on a protease
inhibitorbased triple ART regimen. Only where protease inhibitors are not available, affordable, or
feasible, nevirapine ¬based therapy should be used.

Protease Inhibitor-based

Regimen Lopinavir/ritonavir + 2 NRTIs

COTRIMOXAZOLE PROPHYLAXIS THERAPY (CPT)

Cotrimoxazole prophylaxis therapy (CPT) is a simple, well-tolerated and cost-effective intervention
for infants and children living with HIV. Cotrimoxazole prophylaxis prevents Pneumocystis jiroveci
pneumonia (PCP - formerly Pneumocystis carinii pneumonia), toxoplasmosis and other bacterial
infections. National guidelines stipulate that all HIV exposed infants and children must be initiated
on Cotrimoxazole prophylaxis from 6 weeks (at the first immunization visit or anytime afterwards).
The MO will prescribe one month’s supply of Cotrimoxazole and repeat prescriptions will be done
monthly as per the requirement.

Dosage of Cotrimoxazole prophylaxis

The recommended dose of Cotrimoxazole (5mg/kg of Trimethoprim per day) is given once daily,
either in syrup or paediatric dispersible tablet formulations. Adult Cotrimoxazole tablets should not
be split into quarters and used for infants/children.

Dispersible tablets can be dispersed in expressed breast milk on a clean spoon and fed to the infant
once a day if the child is still breastfeeding. If the child is not being breastfed, boiled water is used
instead of the breast milk.

INFANT FEEDING PRACTICES

(EXCLUSIVE BREASTFEEDING OR EXCLUSIVE REPLACEMENT FEEDING)
Support exclusive breastfeeding for a minimum period of 6 months and continuation of breastfeeds
for 1 year in EID negative babies, and up to 2 years in EID positive babies with initiation of Pediatric
ART. Weaning foods should be introduced from 6 months onwards in all babies whether breast fed
or replacement feeds fed.

The infant feeding guidelines for HIV-exposed and infected infants age 0 to 6 months has been up
dated in 2011. After 6 months of age, complementary foods should be introduced just like for other
infants of this age

Recommendations for infant feeding in HIV exposed and infected infants < 6 months of
age
The 2011 National Guidelines on Feeding for HIV-exposed and infected infants < 6 months old
recommends:

Exclusive breastfeeding for at least 6 months.

Only in situations where breastfeeding cannot be done (maternal death, severe maternal
illness) or individual mother’s choice (at her own risk), then exclusive replacement feeding
may be considered.
Exclusive breastfeeding is the preferred feeding option for HIV-exposed infants LESS THAN 6
months of age. However, it is recognized that for some women, breastfeeding may not be
possible – for example in situations of maternal death and severe maternal illness in which
case Exclusive Replacement Feeding should be done only when AFASS criteria is fulfilled:
AFASS criteria for Exclusive Replacement Feeding
Mothers known to be HIV-infected, if insist on opting for exclusive replacement feeding
which is contrary to the WHO/NACO’s guidelines of giving exclusive breastfeeds for first 6
months, are doing so at their own risk. They should be counselled not to give any breast
feeds during the first six months. MIXED FEEDING should NOT be done during the first 6
months. (Feeding a baby with both breast feeds and replacement feeds in the first 6 months
is known as mixed feeding which leads to mucosal abrasions in the gut of the baby
facilitating HIV virus entry through these abrasions).

When opting for Exclusive Replacement Feeding, they should fulfil the AFASS criteria given below-

 Safe water and sanitation are assured at the household level and in the community, and can
prepare clean feeds.
 The mother or other caregiver can reliably afford to provide sufficient replacement feeding
(milk), to support normal growth and development of the infant, and can sustain it un-
interruptedly for first 6 months at least.
 The mother or caregiver can prepare it frequently enough in a clean manner so that it is safe
and carries a low risk of diarrhoea and malnutrition.
 The mother or caregiver can, in the first six months exclusively give replacement feeding,
and is feasible.
 The family is supportive of this practice, and accepts it without forcing her to breastfeed
during the first 6 months.
 Breastfeeding should NOT be stopped ABRUPTLY.

Points to be Followed for Babies on EBF

 If child found to be HIV negative through EID, continue breast feeding till 12 months. If found
to be HIV positive through EID, continue breast feeding till 2 years.
 All children more than 6 months of age should be started on complementary feeding as per
usual practice .
 ¥ EBF means that infants are given only breast milk and nothing else – no other milk, food,
drinks and water. The infant receives only breast milk and no other liquids, or solids; with
the exception of drops or syrups consisting of vitamins, mineral supplements or medicines.
 § Do not stop breast feeding abruptly. Stop breast feeding gradually according to comfort
level of mother and infant.
  In situations where women opt for replacement feeding or where breastfeeding is not
possible (maternal death or sickness), two options are available:
1. Locally available animal milk (unmodified)

2. Commercial infant feeding formula.

IMMUNIZATION AND VITAMIN A SUPPLEMENTATION

HIV-exposed /infected children should be immunized according to the following schedule:

 Live vaccines should be avoided in all severely immune compromised infants (CD4 %< 25%
or WHO stage 3 and 4).
 Vitamin A supplementation should be as per the national immunization schedule.
 National Immunization schedule is as follows:
Immunization chart for children living with HIV
FOLLOW-UP OF HIV EXPOSED INFANTS AND CHILDREN
 In view of ARV prophylaxis to all exposed babies for at least 6 weeks of age, the first follow
up visit should be at 2 weeks of age. During the first follow up visit at 2 weeks of life, child
should be looked for any adverse reaction to NVP. The subsequent visits should be according
to the immunization schedule starting at 6 weeks of age.
 The road to health card for HIV-exposed children will include information on maternal HIV
status, Cotrimoxazole prophylaxis, infant HIV diagnosis and infant feeding information.

COUNSELLING AND PSYCHOSOCIAL SUPPORT

Appropriate counselling is ultimately the responsibility of the team providing care to the HIV
exposed infant and child. This would include.

counseling on PPTCT

 ARV prophylaxis,
 infant feeding, ▪
 nutrition, ▪
 EID,
 CPT initiation
 Vaccination
 opportunistic infections
 ART therapy and adherence

Counsellors must make sure that the psychosocial issues have been dealt appropriately. If the
child is infected, the parent or the care giver must be explained what to expect with regard to
the health of the child, starting of ART, prophylaxis for various OIs, and how to take care of the
child. Counselling and psychosocial support is the cornerstone of the management of HIV
infected or affected families.

NURSE’S ROLES AND RESPONSIBILITIES

Nursing Diagnosis 1 - Risk for Infection related to immunosuppression
Interventions

 Assess the child every 2–4 hours for fever; lesions in the mouth; redness, inflammation,
soreness, and lesions on the skin or around intravenous lines.
 Auscultate for changes in breath sounds every 2 hours.
 Enforce strict handwashing.
 Allow no fresh flowers, fruits, or vegetables in child’s room.
 Administer appropriate immunization as prescribed.
 Appropriate feeding practices should be taught to the mother.

Nursing Diagnosis 2 – Altered nutrition less than the body requirement related to recurrent
illnesses

Interventions

 Encourage the mother for proper feeding method.

 Monitor weight and growth of the child.
 Provide meals when child is most likely to eat well.

Nursing Diagnosis 3 – Knowledge Deficit (Parent) related to home care of child with AIDS

Interventions

 Encourage the mother for proper feeding method.

 Explain about the importance of AIDS treatment and adherence to the ARV prophylaxis.
 Explain about the side-effects of the drugs.

Nursing Diagnosis 4 – Altered family process related to having a child with a life-threatening
disease.

Interventions

 Explain the condition of the child to the family members.

 Encourage the family members to participate in mother and child care.
 Give psychological support to the mother and family members.

Nursing Diagnosis 5 – Anticipatory loss related to having a child with potentially life-threatening
disease.

Interventions

 Give psychological support to the mother and family members.

 Explain about the condition of the infant, treatment and prognosis.

CONCLUSION
The HIV epidemic is a serious global challenge that continues to take its toll, particularly on
vulnerable populations, such as children. Living with HIV/AIDS brings many implications to families,
parents, mother and child, including stigma/ discrimination, poverty, food insecurity, loss of health
leading to inability to work and generate income etc. Globally, the World Health Organisation (WHO)
has recommended the implementation of Early Infant Diagnosis (EID) and treatment among HIV
exposed infants to achieve the 2030 goal of HIV elimination. In the absence of any intervention, a
substantial proportion of children born to women living with HIV, acquire HIV infection from their
mothers either during pregnancy, labour/delivery or during breastfeeding. Appropriate treatment
can help in better life of the child.

BIBLIOGRAPHY
 John P. Cloherty, MANUAL OF NEONATAL CARE, 7 th edition,Lippincott publication,
page no: 622-624.
 Lange,Neonatology management, procedures,on call problems,diseases and drugs,
5th edition, page no: 711-715.
 Ghai O.P etal, Ghai essentials of paediatrics, 6 th edition, page no: 220-225.
 Wong L. Donna etal, Wong’s essentials of paediatric Nursing, 6 th edition, page no:
1019-1024.

NET REFERENCES
 INDIAN JOURNAL OF PUBLIC HEALTH - https://www.ijph.in/article.asp?issn=0019-
557X;year=2017;volume=61;issue=2;spage=124;epage=130;aulast=Nath
 NACO EID ALGORITHM -
http://www.naco.gov.in/sites/default/files/DBS_Sample_Collection_for_EID_Modul
e_Read_Only.pdf
 WHO (PEADIATRIC CARE)- https://www.who.int/hiv/pub/toolkits/3-2-
7_Pediatrics_9Feb09.pdf.
 RESEARCH ARTICLE 2 - https://www.indianpediatrics.net/jan2020/34.pdf
 NACO EID- http://naco.gov.in/sites/default/files/Technical%20Brief%20on
%20EID.pdf
 NACO PEDIATRIC ART GUIDELINES -
http://www.naco.gov.in/sites/default/files/Pediatric_14-03-2014.pdf
 NACO PPTCT GUIDELINES -
http://naco.gov.in/sites/default/files/National_Guidelines_for_PPTCT.pdf