CARE OF CHILD WITH HIV

Presented by :
Smt. Priya B. shinde,
M.Sc. Nursing 1st Year
D.Y. Patil College of Nursing,
Kolhapur
 HIV DEFINITION
HIV (human immunodeficiency
virus) is the virus which attacks the
T-cells in the immune system.
 AIDS DEFINITION
AIDS (Acquired immunodeficiency syndrome) is the
syndrome which appears in advanced stages of
HIV infection

 HIV isa virus

 AIDS is a medical condition
 CAUSATIVE VIRUS
HIV (human immunodeficiency virus).
 TYPE OF HIV
1.HIV 1
 subtypes (A-J).
 In India & China C subtype is common
2. HIV-2
 In West Africa and the surrounding countries.
 HIV-2 is less fatal and progresses more slowly than
HIV-1.
PATHOGENESIS
 Clinical manifestation:
 Major signs:
 Weight loss or abnormally slow growth.
 Chronic diarrhoea of more than 1 month duration.
 Prolonged fever of more than month duration.
 Minor signs:
 Generalized lymphadenopathy
 Oropharyngeal candidiasis
 Repeated common Infections Persistent cough
 Generalized dermatitis
 Confirmed maternal HIV infection.
 WHO Clinical Staging of HIV in Children
staging in children with HIV is done based on clinical
signs and symptoms
Clinical stage 1
 Asymptomatic
 Persistent generalized lymphadenopathy
 Clinical stage 2
 Unexplained persistent hepatosplenomegaly
 Fungal infection
 Angular cheilitis
 Recurrent oral ulceration
 Unexplained persistent parotid enlargement
 Herpes zoster
 Recurrent or chronic upper respiratory tract infections
(otitis media, otorrhea, sinusitis, tonsillitis)
 Clinical stage 3
 malnutrition
 Unexplained persistent diarrhoea (14 days or more)
 persistent fever
 Lymph node TB
 Pulmonary TB
 Severe recurrent bacterial pneumonia
 Chronic HIV-associated lung disease including
bronchiectasis
 Unexplained anemia
 Clinical stage 4
 severemalnutrition
 pneumonia
 Recurrent severe bacterial infections (joint infection,
meningitis)
 Chronic herpes simplex infection
 Extrapulmonary/disseminated TB
 Kaposi sarcoma
 Cytomegalovirus infection
 HIV encephalopathy
 Diagnostic Evaluation
 Physical examination
 History collection
 Laboratory Investigations
 ELISA test (Enzyme-linked immunosorbent assay test)
 Western blot test
 CD4
 T cell ratio and T cell growth factors.
 HIV specific PCR (polymerase chain reaction)
 Nucleic Acid Test (NAT) (HIV viral load test)
 Management
The goals for these medicines are to:
 Control the growth of the virus
 Improve how well your immune system works
 Slow or stop symptoms
 Prevent transmission of HIV to others
Cont…

 Nucleoside/Nucleotide Reverse Transcriptase

Inhibitors (NRTIs)
Zidovudine or ZDV
 Non-nucleoside Reverse Transcriptase Inhibitors
(NNRTIs)
Nevirapine or NVP
 Protease Inhibitors (PIs)

Indinavir or IDV
Lopinavir + ritonavir or LPV/r
Cont…

 Integrase Inhibitors
Raltegravir or RAL
 Fusion Inhibitors

Enfuvirtide or ENF
 Gp120 Attachment Inhibitor

Fostemsavir
 CCR5 Antagonist

Maraviroc
The uses of ARV regimens in newborns include the
following:
 ZDV zidovudine
≥ 35 Weeks’ Gestation at Birth
 ZDV 4 mg/kg per dose orally twice daily
 ZDV 12 mg/kg per dose orally twice daily; makes
this dose increase only for infants with confirmed
HIV infection.
 Cont…
 NVP nevirapine
 ≥37 Weeks’ Gestation at Birth
 NVP 6 mg/kg per dose orally twice daily
 NVP 200 mg/m2 BSA per dose orally twice daily;
only make this dose increase for infants with
confirmed HIV infection.
 Cont…

ABC abacavir
≥ 37 Weeks’ Gestation at Birth
ABC 2 mg/kg per dose orally twice daily
ABC 4 mg/kg per dose orally twice daily
3TC = lamivudine
≥32 Weeks’ Gestation at Birth
3TC 2 mg/kg per dose orally twice daily
3TC 4 mg/kg per dose orally twice daily
 Nursing Management:
NURSING ASSESSMENT
 Review maternal records
 Assess growth, development, microbial infections.
 Assess the family’s understanding of child”s condition
 Assess family’s coping mechanisms, comfort with disclosure issues
  Assess health of primary caregiver and discuss long-term care
plans
 Assess the child’s understandings and health status and medications.
 Assess the level of pain and discomfort.

 Nursing diagnosis
 Risk for infections related to immunodeficiency state.
 Altered nutrition related to anorexia, pain abdomen and
malabsorption.
 Altered oral mucosa related to stomatitis, or candidiasis.
 Diarrhea and dehydration related to enteric pathogens
and infections.
 Altered body temperature, more than normal, due to HIV
infection and secondary infections.
 Pain related to advanced HIV diseases.
 Cont…
 Altered growth and development related to HIV
infections and CNS involvement.
 Ineffective family coping related to chronic fatal
illness of the child.
 Fear and anxiety related to diagnostic and treatment
procedures.
 Knowledge deficit regarding transmission of HIV
infection, care at home and available social support.
 NURSING CARE
Implementation of nursing care should include
 preventing infections
 Maintaining adequate nutrition
 improving Integrity of oral mucosa
 minimizing the effects of diarrhoea and preventing
 Dehydration, assessing general conditions and vital
signs, controlling fever,
 promoting growth and development
Cont…

reducing fear and anxiety,

improving coping abilities
informing and educating about
care of the child at home and
prevention of transmission.
 PREVENTION
Mother is given Zidovudine 100 mg, 5 times per day,
orally from fourth week of gestation till delivery.
At the time of delivery 2 mg/kg IV, Zidovudine is
given in the first hour of labor followed by
1mg/kg/hour till delivery.
The newborn is also given Zidovudine, 2 mg/kg
every 6 hourly till 6 weeks of life.
 ASSIGNMENT
 Writein brief nursing management about
HIV/AIDS .