Download presence of passively transferred maternal antibody up to 18 months

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