HIV In Children

 Dr. C. S. REX SARGUNAM MD (Ped), DCH

PEDIATRIC CONSULTANT

VHS

Global Scenario of HIV / AIDS (Dec 2004)

                                            HIV / AIDS Situation in Tamilnadu

                                            Transmission of HIV in Children

                                            Prevention of Perinatal Transmission

                                            Diagnosis

                                            Antibodies     ELISA, WB

                                            Antigen   PCR, Viral Culture, P₂₄

                                            ART

                                           Clinical Features

                                           Laboratory Diagnosis – CD4, Cell Count, CD4, CD8 Ratio, TC & DC

           ON MANY A OCCASION, IT IS THE DISCOVERY OF HIV INFECTION IN  AN 

                           INFANT LEADS TO THE DETECTION OF HIV IN PARENTS  

          Who Staging System for HIV Infection and Disease for Infants and Children ?

                Clinical Stage I

                              Asymptomatic

                              Generalized Lymphadenopathy (PGL)

               Clinical Stage II

                                         Hepatosplenomegaly

                              Papular pruritic eruptions

                              Seborrhoeic dermatitis 

                              Extensive human papilloma virus infection

                              Extensive molluscum contagiousum

                              Fungal nail infections

                              Recurrent oral ulcerations

                              Lineal gingival erythema (LGE)

                             Angular cheilitis

                             Parotid enlargement

                             Herpes zoster

                             Recurrent or chronic RTIs (otitis media, otorrhoea, sinusitis)

              Clinical Stage III

                            Conditions where a presumptive diagnosis can be made on the

                             basis of clinical signs or simple investigations

                                       Moderate unexplained malnutrition not adequately responding to      standard therapy

                              Unexplained persistent diarrhoea (14 days or more)

                              Unexplained persistent fever (intermittent or constant, for longer than      one   month)

                              Oral candidiasis (outside neonatal period)

                             Oral hairy leukoplakia

                             Acute necrotizing ulcerative gingivitis/periodontitis

                              Pulmonary TB

                             Severe recurrent presumed bacterial pneumonia

               Conditions where testing is necessary

                             Chronic HIV-associated lung disease including bronchiectasis

                             Lymphoid interstitial pneumonia

                             Unexplained anaemia (<8g/ dl), and/or neutropoenia (<1000/mm_) and/or thrombocytopenia (<

                             50,000/mm_) for more than one month

                             CMV infection (CMB retinitis or infection of organs other than liver, spleen or lymph nodes;

                             Onset  at  age one month or more)

                             Extrapulmonary cryptococosis including meningitis

                             Any disseminated endemic mycosis (e.g. extrapulmonary Histoplasmosis, coccidiomycosis, pencilliosis)

                             Cryptosporidiosis

                             Isosporiasis

                             Dissemimated non-tuberclosis mycobacteria infection

                              Candida of trachea, bronchi or lungs

                             Visceral herpes simplex infection

                             Acquired HIV associated rectal fistula

                             Cerebral or B cell non-Hodgkin lymphoma

                             Progressive multifocal leukoencephalopathy (PML)

                             HIV-associated cardiomyopathy or HIV-associated nephropathy

 EVENTFUL COURSE OF AN ILLNESS IN AN INFANT DO HIV TESTING MANAGEMENT

                              No Sympathy but Empathy

                              Psychological & Social Support

             Nutrition

                             Proteins of high biological value –Milk, Egg, etc

                             Calorie rich carbohydrate – Honey, Jam

                             MCT – Medium Chain Triglycerides

             Full Immunization

                                     Tr eat the Specific Infection AndSymptomatic Treatment Cotrimoxazole Prophylaxis if necessary.

             ART for Children

                           General Principle

                           Zidovudine (ZDV)

                  CONCLUSION

HIV in our children, is not a possibility, It is a reality.