Paediatric HIV. February

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Phebe Reynolds
5 years ago
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1 Paediatric HIV February

2 Epidemiology Natural History Clinical presentation Diagnosis Staging Eligibility HAART Monitoring Disclosure

6 Natural history

8 Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-saharan Africa

9 Without treatment, approximately one-half of children with vertically acquired HIV infection will die by the age of two years.

10 Clinical presentation

17 Diagnosis

19 Testing for HIV

21 Diagnosis <12 months

27 The increasing availability of ART has resulted in a substantial rise in the life expectancy of children living with HIV in low-income countries, so that increasing numbers of children are surviving to adolescence and beyond

28 Baby follow up Aim to stop breastfeeding around age 22 months, so that the final HIV test can be done at age 24 months (6 weeks after breastfeeding has stopped).

29 Some difference between adults and children

30 VL is very high in children

32 CD4 is physiologically lower in young children

33 CD4/CD8 ratio months after seroconversion CD4 30% CD8 40% Reverts towards normal on ART

35 Masha 7 years with fever and convulsions

36 CNS problems in HIV + children Secondary to HIV Vascular Infective Neoplasms Primary HIV related Hypercoagulable Vasculopathy Viral - CMV, HSV, VZV Fungal cryptococcal Protozoa Toxoplasmosis Bacterial TB Multifocal B cell tunours

37 Primary HIV related - HIV encephalopathy HIV enters the central nervous system (CNS) via the microglial cells (the monocytes of the CNS). This sets in motion a neurotoxic process leading to neuronal cell death. May resemble children with other causes of cerebral palsy. The encephalopathy may be static or progressive. Static HIV encephalopathy is more common and involves global cognitive and motor deficits with a normal rate of learning. Progressive HIV encephalopathy, the most severe form of HIV encephalopathy, occurs almost exclusively in untreated HIV and involves severe developmental delay or regression of developmental milestones.

HIV encephalopathy Impaired brain growth. In children <2 years of age, impaired brain growth manifests as deceleration of head growth or acquired microcephaly.

38 HIV encephalopathy Impaired brain growth. In children <2 years of age, impaired brain growth manifests as deceleration of head growth or acquired microcephaly. Progressive bilateral pyramidal tract signs. These include bilateral tone abnormalities and onset of pathologic reflexes (hyperreflexia and clonus), chiefly affecting the legs

39 Respiratory illness in infants with HIV - PJP

41 CVS CVS problems in HIV + children Secondary to HIV/drugs Primary HIV related Myocarditis NRTI AZT dilated cardiomyopathy Cardiomyopathy Left ventricular dysfunction PI premature atherosclerosis, lipid abnormalities and insulin resistance

42 GIT Immune deficiency IgA, acid production in the stomach Malnutrition T cell function HIV Enteric infection Malabsorption activity of brush border enzymes especially lactase

GI presentation's Gingival infection Recurrent

ABC Abdominal pain pancreatitis - ABC, 3TC

43 GI presentation's Gingival infection Recurrent aphthous ulcers Oral thrush Oesophagitis Nausea and vomiting cryptosporidium, ARTs e.g. ABC Abdominal pain pancreatitis - ABC, 3TC Hepatomegaly ART Diarrhoea Salmonella, Shigella, giardia, cryptosporidium, campylobacter, CMV, lactose intolerance, ARTs

45 Disclosure

46 Parents perspective If I tell my child that she is HIV positive, she will definitely ask me how she got infected. This is not easy for me to tell the child about my status as well for she will think that I was promiscuous and this will also lead me into telling the child about sex and also about my HIV status.. (Mother of 11 year girl)

47 Health care workers also struggle.. One time a nurse accidentally mentioned HIV in the presence of the child and the child got angry with the mother that she had been lying to him about the medication. The mother used to tell the child that he was on anaemic drugs. The child then stopped taking the medications for some time. Now we just give the medications without saying anything because we don t have a strategy on handling this issue

48 The process of disclosure Who How When Where

PAEDIATRIC HIV INFECTION. Dr Ashendri Pillay Paediatric Infectious Diseases Specialist

PAEDIATRIC HIV INFECTION. Dr Ashendri Pillay Paediatric Infectious Diseases Specialist PAEDIATRIC HIV INFECTION Dr Ashendri Pillay Paediatric Infectious Diseases Specialist Paediatric HIV Infection Epidemiology Immuno-pathogenesis Antiretroviral therapy Transmission Diagnostics Clinical