HIV IN CHILDREN

HIV is Human immunodeficiency virus (HIV) is the virus that is responsible for causing
acquired immune deficiency syndrome (AIDS).

The virus destroys or impairs cells of the immune system and progressively destroys the body's
ability to fight infections and certain cancers.

AIDs are the acquired immune deficiency syndrome.

Modes of transmission

• Mother to child transmission during pregnancy, at time of delivery, during breast feeding

• Transfusion with HIV infected blood

• Contaminated sharp instruments, e.g. dental & surgical equipment, needles. Etc

• Unprotected sexual intercourse with infected person.

Clinical presentation

Presentation is in 4 stages according to WHO paediatric staging for HIV infections;

Stage 1;

 Persistent generalized
 Lymphadenopathy (PGL)

Stage 2 (mild disease)

• Chronic upper respiratory tract infections, e.g. sinusitis, tonsillitis

• Enlarged liver or spleen

• Enlarged parotid gland

• Skin conditions, e.g. dermatitis, fungal nail infection, herpes zoster, extensive warts

• Mouth conditions, recurrent mouth ulcerations, linear gingival erythematic

Stage 3 (moderate disease)

• Oral thrush

• Oral hairy leukoplakia

• Diarrhea for over 14 days

 • Fever for over one month

• Anemia for over one month( H.b <8g/L

• Recurrent severe bacterial pneumonia

Stage 4 (severe disease) AIDS

• Severe acute malnutrition not responding to standard therapy

• Esophageal thrush

• Kaposi sarcoma

• Cryptococcus meningitis.

Approach to diagnosis

• HCW counsel all HIV-infected pregnant or postpartum mothers on need to confirm status
of the child

• Have a high index of suspicion

• RCT for sick children in high HIV prevalence areas

• Use appropriate test where available

• Use antibody test if PCR unavailable and treat presumptively where necessary

Diagnosis

• History and Assessment

• Clinical features

• And laboratory diagnosis;

-rapid test for antibodies

-virological test using DNA/PCR test

Objectives of HIV Care

• Prevention of infection (vertical and horizontal)

 • Promote normal growth and development

• Provide a good quality of life

• Halt progression of disease

• Prevention and treatment of HIV associated clinical problems

Prolong survival

Principles of Care – The Ten Point Management Plan

• Early diagnosis of HIV infection

• Growth and development monitoring

• Immunisations – routine EPI & de-worming

• Nutrition education, support and supplementation – macro and micronutrients (Vitamin A

& Multivitamins)

• Aggressive treatment of acute infections

• Prophylaxis and treatment of opportunistic infections (PCP prophylaxis)

• Psychosocial support

• Adolescent care and support

• Mother and family care – MTCT Plus

• Antiretroviral therapy when available and indicate

MANAGEMENT OF SEXUAL VIOLENCE

 Rapid HIV counseling
 PEP if HIV negative
 STI screening hence emergency contraception with 72 hours
 Psychological support

ANTNATAL AND elimination of MOTHER TO CHILD

TRANSMISSION services for pregnant mothers
 Health education on HIV, syphilis testing and re-test every 3 months, test
for hepatitis B, screen for GBV, refer risk partners for Safe Male
Circumscion
 Link HIV positive pregnant women and partners to care and treatment
  Provide PREP to discordant partners
 For HIV negative retest every three months
 Provide ANC package for any other pregnant women e.g. 8 visits, folic
acid, de-worming in 2nd trimester
 Provide nutrition assessment ,TB screening, BP at every visit
 Provide adolescent friendly services, test for syphilis, BP group and cross
matching, sickling test, CD4 count, urinalysis
 For newly diagnosed mothers do viral load at 6 and 12 months after
initiating them on ART.

DURING LABOUR
 Retest HIV negative mothers, reduce
MTCT, maternal and infant mortality
 Use portogram to prevent prolonged labor,
avoid routine rapture of membrane.
 Don’t perform episiotomy except for
specific obstetrical indications
 Avoid frequent vaginal examination

ART PROPHYLAXIS FOR EXPOSED INFANT

 Initiate Nevirapine prophylaxis for the infant at birth or at the earliest opportunity after
birth
 Initiate breastfeeding within 30 minutes after delivery
 Infant feeding to the mother according to maternal guidance and choice
 Counsel mother and provide an appointment for postnatal services EID and 6 days weeks

GROWTH, MONITORING AND NUTRITION

 Conduct child growth monitoring MUAC length
and weight
 Pay attention to growth failure this may be an
indication to HIV infections
  Counsel mother to take appropriate action

TREATMENT FAILURE – IMPLICATIONS

• Patient is not taking the drugs, or taking them irregularly (non- or poor adherence)

• Patient is taking inadequate doses of the drugs

• Patient is taking other medications interacting with the drugs

• Patient is taking all the drugs in the correct doses but the virus is resistant

INDICATORS OF DRUG FAILURE

• One can usually expect significant clinical improvement within 3 months of starting ART

• Clinical

– No improvement or worsening of clinical status after 3 months of ART

– Decline in growth after initial response

– Loss of milestones

– Encephalopathy

– New OI’s or recurrence of previously treated ones (exclude IRIS)

• Virological

– <0.5-0.75% log10 reduction in load within 4 weeks

– <1.0 log10 reduction within 24 weeks

– Failure to be undetectable within 4-6 months

– Repeated detection of virus after initial undetectable

REGULAR FOLLOW-UP CARE

• Regular follow-up is the backbone to caring

• Ensures optimal health care and psychosocial support

 • WHO recommends minimum follow-up of exposed infant;

– At birth

– Age 1-2 weeks

– 6, 10, 14 weeks

– Every month until age 12 months

– Thereafter every 3 months depending on condition

CONCLUSION

Care providers can do more to improve the care and quality of life of HIV-exposed and infected
children However limited the resources, there is always something that can be done for an
individual child.