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CHILDREN and HIV Basic information: 75% of children living with HIV (CLHIV) present with symptoms in the first or second year of life (most often at the primary level clinic). 75% of children Infected and affected by HIV are severely malnourished. Nutrition requirement for an asymptomatic CLHIV is an additional 10% of calories while in symptomatic phase they require 30% more. >40% of HIV-infected children die before 2 years of age. 80% of infant deaths occur at home Differences in HIV between adults and children • Immature immune systems - susceptible to infections (OIs). • Carry maternally-acquired antibodies below 18 months. A PCR is required • Normal CD4 counts are higher in young children than in adults. • ARV drugs are handled differently in children – affecting dosage needed. Dose adjusted to weight. • Counseling children for disclosure of their HIV status, to discuss ART, and to support adherence to ART requires special skills in communication. • Need to simplify language Routes of transmission • In order of occurrence as: – The most common route is Mother to Child Transmission of HIV during pregnancy (intra partum), delivery (peri partum) and during Breast Feeding (Post Partum). – Repeated Blood transfusions of contaminated blood in the treatment of Thalessemia, Hemophilia and Leukemia. – Sexual Route: through sexual abuse and early sexual exposure by unprotected sex. Mother to Child Transmission of HIV Types of Infant Feeding Practice • Exclusive Beast feeding • Replacement Feeding • Mixed Feeding DIAGNOSIS OF PEDIATRIC HIV Testing algorithm Infants: presence of passively transferred maternal antibody up to 18 months HIV Exposed child 6 wks to 9 months DNA PCR 9 to 18 months HIV Antibody >18 months HIV Antibody DNA PCR If breastfeeding: repeat age-appropriate tests at least 6-8 weeks after stopping breastfeeding. Presumptive diagnosis of severe HIV disease in infants and children aged <18 months When virological tests are NOT available HIV Antibody positive AND AIDS indicator condition (e.g. Pneumocystis pneumonia, cryptococcal meningitis, HIV wasting, Kaposi sarcoma, extrapulmonary tuberculosis.) OR HIV Antibody positive AND Infant is symptomatic with 2 or more of the following: - oral thrush - severe pneumonia - severe sepsis Supportive evidence: - recent HIV-related maternal death or advanced maternal HIV dis. %CD4+ <20. - ART Questions when starting ART WHO? WHAT? WHEN? HOW? Influencing factors: Child: 1. Depend on adults 2. Taste, smell, color 3. Emotional Factors 4. Frequency and other medicines 5. Experiment - ? If I do not take Caregiver: 1. 2. 3. Understanding of Hiv Misconceptions of ART Their own health, daily routine and closeness with the child