DR. SATTI A/RAHIM SATTI CONSULTANT PEDIATRICION
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1 A I D S IN CHILDREN BY DR. SATTI A/RAHIM SATTI CONSULTANT PEDIATRICION
2 INTRODUCTION AIDS is the end stage of symptomatic HIV infection. HIV infection progresses more rapidly in children than in adults. A long latency period bet. the time of infection and the development of clinical symptoms. 2
3 ETIOLOGY THE VIRUS: HIV 1 & 2 are members of the genus lentivirus, family retroviridae. Both cause AIDS. Each virus contains 2 copies of the RNA genome. 3
4 ETIOLOGY CONT THE VIRUS USE THE ENZYME REVERSE TRANSCRIPTASE TO REVERSE THE USUAL FIOW OF GENETIC INFORMATION. 4
5 5 HIV Virus
6 MODES OF INFECTION 1. BLOOD OR BLOOD PRODUCTS. 2. VERTICAL TRANSMISSION: ** THE COMMONST. INTRAUTERINE 40% INTRAPARTUM 60% BREAST FEEDING 14% 6
7 3. I V ( Drugs). 4. SEXUAL CONTACT: RARE. 5.URINE OR FECES: FEW CASES. NOT THROUGH SALIVA. 7
8 RISK FACTORS GENERAL: 1.GENDER. 2.UNDERDEVELOPED C. 3.LACK OF EDUCATION. 4.LOW ECONOMIC STATE. 5.INTRAVENOUS DRUG VERTICAL TRANS. 6. MICRONUTRIENT DEFICIENCY IN MOTHER. 7. PLACENTAL ABRUPTION. 8. IUGR OR PRETERM. 9. PROM. 10. VAGINAL DELIVARY EPISIOTOMY.
9 PATHOGENESIS C M & humoral immunity occur early. Gradual deterioration of the immune system i.e of CD4 cells 9
10 CLINICAL MANIFESTATIONS Asymptomatic phase. After vertical transmission there are 3 distinct patterns of the disease : 1. Rapidly progressing 15% 80% 2. Slowly 3. Long term survivors <5% 10
11 INFANTS : Failure to thrive. Hepatosplenomegaly. Lymphadenopathy. Chronic diarrhea. Oral thrush. Interstitial pneumonia. 11
12 CHILDREN : FEVER. DERMATITIS. RECURRENT BACTERIAL INFECTIONS. H S V DISSEMINATED MYCOBACTERIAL INFECTIONS. VARICELLA. 12
13 CANDIDIASIS. PCP LIP PAROTID. HEPATITIS. NEUROLOGIC DETERIORATION. 13
14 INFECTIONS 1.RECURRENT BACTERIAL INFECTIONS: ORGANISMS: STAPH, SALMONELLA, PNEUMOCOCCUS, ENTEROCOCCUS,H.INFLUENZAE & Ps. AERUGINOSA. 14
15 15 GET : SEPSIS. BACTEREMIA. PNEUMONIA. MENINGITIS. U T I ABSCESSES. BONE INF. OTITIS MEDIA. SINUSITIS SKIN INFE.
16 2.OPPORTUNISTIC INFECTIONS: LESS COMMON IN CHILDREN. A) PNEUMOCYSTIS CARNII P.: THE MOST COMMON. ACUTE FEVER DYSPNEA R R HYPOXEMIA THERAPY: SEPTRIN + STERIODS. PENTAMIDINE 16
17 17 X-ray of PCP
18 OPPOR. INF.CON C) ORAL THE MOST COMMON FUNGAL R/ NYSTATIN CLOTRIMAZOLE TROCHES AMPHOTERICIN MAY INVOLVE OESOPHAGUS. ORAL FLUCONAZOLE 18
19 OPPOR. INF. CON d) PARASITIC INFECTIONS: = GIARDIASIS = INT.CRYPTOSPORIDIOSIS. = SEVERE CHRONIC DIARRHEA. = MALNUTRITION. 19
20 OPPOR. INF. CON. E) VIRAL INFECTIONS: HERPES SIMPLEX: - RECURRENT GING. STOM. - CUT. DISSEMINATION. V ZV : - VISCERAL DISSEMINATION - HERPES ZOSTER. - LUNGS 20
21 SYSTEMS AFFECTED 1. C N S : ** More common than in adults. ** Most common presentation is : progressive encephalopathy. ** May get : seizure. focal signs. ** Lymphoma. ** Toxoplasmosis. ** Cryptococcal meningitis. 21
22 2. RESP. SYS. : & RECURRENT O. M. AND SINUSITIS. & MASTOIDITIS. & L I P : 25% OF PTS CHRONIC CLUBBING 22
23 & PNEUMONIA : = MANY ORGANISMS. = RESP. FAILURE. = DEATH. & BRONCHIECTASIS : RARE & T B : = MORE FREQUENT. = ALSO EXTRAPULMONARY. 23
24 3. C V S : = SUBCLINICAL ABNOR. ARE COMMON. = DILATED CARDIOMYOPATHY. = C H F (5%) 24
25 4. G I & HEPATOBILIARY TRACT: # ORAL : HAIRY LEUKOPLAKIA. ULCERATIONS. CANDIDA. # ESOPHAGEAL ULCERATIONS. # A I D ENTEROPATHY : SYNDROME OF MALABSORPTION. VILLOUS ATROPHY. 25
26 # WASTING SYNDROME : LOSS OF > 10% WT. BAD PROGNOSIS. # COMMON SYMPTOMS : DIARRHEA ABD. PAIN DYSPHAGIA F T T 26
27 # Chronic hepatitis. # Cholecystitis. # Pancreatitis. 27
28 5. RENAL DIS. : $ NEPHROPATHY $ NEPHROTIC SYND. : THE MOST COMMON. $ HEMATURIA $ POLYURIA OR OLIGURIA. 28
29 29
30 7. HEMATOLOGIC & MALIGNANT DIS. ANAEMIA : UP TO LEUKOPENIA & THROMBOCYTOPENIA IN20% 30
31 @ CLOTTING FACTORS MALIGNANCY : RARE CNS LYMPHOMA. NON-H. LYMPHOMA. LEIOMYOSARCOMA. KAPOSI SARCOMA. ^HHV8 ^UNCOMMON 31
32 DIAGNOSIS Ab TEST (TILL 18 mo. AGE.) TEST FOR HIV Abs (EIA) CONFIRMED BY : WESTERN BLOT. I F ASSAY. ( FOR >18 mo.age.) 32
33 VIRAL DIAGNOSTIC TESTING: * DNA PCR * RNA PCR * HIV CULTURE * P24 Ag ASSAY (ICD-P24) CD4 &CD8 COUNT. CBC 33
34 TREATMENT Combinations of H A A R T which include at least 3 drugs, should be the initial R/ Therapy only suppresses the virus & changes the course of the disease to a chronic process. 34
35 # DECISIONS ABOUT THERAPY ARE BASED ON: VIRAL LOAD. CD4 COUNT. CLINICAL CONDITION. # CALLED ANTI-RETROVIRAL THERAPY. 35
36 THE DRUGS 1..NRTIs ( Nucleoside Reverse Transcriptase Inhibitors ) : ZIDOVUDINE (ZDV) ABACAVIR (ABC) 36 LAMIVUDINE (3TC) DIDANOSINE (ddi) STAVUDINE (d4t) DIDEOXYCYTIDINE (ddc) EMTRICITABINE TENOFOVIR VIDEXEC. ZENT XR
37 2..NNRTIs ( Non-nucleoside Reverse Transcriptase Inhibitors) : DELAVIRDINE (DLV) NEVIRAPINE (NVP) EFAVIRENZ 37
38 3.P Is ( Protease Inhibitors) : * INDINAVIR (IDV) * SAQUINAVIR. * AMPRENAVIR (APV) * ATAZANAVIR * RITONAVIR (RTV) * FOSAMPRENAVIR. * LOPINAVIR (LPV) * TIPRANAVIR * NELFINAVIR * DARUNAVIR. 38
39 TREAT. CON WHO = SHOUD BE TREATED ARE THOSE WITH :!! SYMPTOMS.!! OR EVIDENCE OF IMMUNE DYS. INCREASE DOSING INTERVAL OF DRUGS FOR NEWBORNS & PREM. 39
40 SUPPORTIVE CARE MULTIDISCIPLINARY TEAM APPROACH. NUTRITION. B F : IN DEVELOPING C. HIV INFECTED MOTHERS SHOUD B F THEIR INFANTS. (WHO) ATTENTION TO ORAL HYGIENE. REGULAR EVALUATION OF G & D + TEETH. 40
41 SUPPOR. CARE CON IMMUNIZATIONS : ALL STANDARD VACCINES. DO NOT GIVE OPV & LIVE BACT. VS. MMR & VARICELLA TO SEVERLY IMMUNOCOMPROMIZED PTS 41
42 SUPPOR. CARE CONT.. PAIN MANAGEMENT. ADVICE TO PARENTS e Counseling. SUPPORT. 42
43 PREVENTION ZDV CHEMOPROPHYLAXIS : DURING PREGNANCY. DELIVERY. NEWBORN. NEVIRAPINE ( oral) : ONCE IN LABOUR. TO INFANT (IST 72 Hs) o HAART regimen for their own health during pregnancy. 43
44 Potential benefit of CS in reducing the risk for Vertical transmission. HIV Ab TESTING : ALL PREGNANT. DURING LABOR. IST DAY OF LIFE. 44
45 PREVENTION- CONT. CONDOMS TO SEXUALLY ACTIVE ADOLESCENTS. NO MULTIPLE PARTNERS. NO ILLICIT DRUGS. CIRCUMCISION REDUCE THE RISK OF HIV INFECTION. CDC considers promoting circumcision August
46 46 ROLE OF ISLAMIC RULES IS THE CORE IN THIS ISSUE OF PREVENTION
47 VACCINES SUBUNIT VACCINES : FIRST TYPE: CALLED COMPONENT V. GENETIC ENGINEERING. 2 ND TYPE : CALLED AVIRUS- LIKE PARTICLE. 47
48 VACCINES CONT. * RECOMBINANT VECTOR VACCINES : VIRUSES OR BACTERIA USED AS CARRIERS. * DNA VACCINES : LAB MADE HIV DNA IS INTRODUSED INTO THE BODY. 48
49 49 THANK YOU
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