Ch 47: Peds AIDS Flashcards
HIV process
Infects CD4+ T cells
gradual decrease in these cells occurs
causes progressive immunodeficiency
HIV transmission
blood, semen, vaginal secretions, and breast milk
incubation period is months - years
Most common opportunistic infections in HIV children
Pneumocystic jiroveci pneumonia
most frequently occurs between the ages of 3-6 mo.
Common assessment findings in HIV children
chronic cough chronic / recurrent diarrhea dev. delay or regression of milestones failure to thrive hepatosplenomegaly lymphadenopathy malaise and fatigue night sweats oral candidiasis parotitis weight loss
Common AIDS defining conditions in children
candidal esophagitis cryptosporidiosis cytomegalovirus disease herpes simplex disease HIV encephalopathy lymphoid interstitial pneumonitis Mycobacterium avium intracellulare infection Pneumocystic jiroveci pneumonia pulmonary candidiasis recurrent bacterial infections wasting syndrome
Antiretroviral meds
bgoal is to suppress viral replication to slow the decline in number of CD4 cells, preserve immune fxn, reduce the incidence and severity of opportunistic infections, and delay disease progression.
meds affect different stages of the HIV life cycle to prevent reproduction of new virus particles
Immunizations
immunizations against childhood diseases is recommended for all children exposed to / infected w HIV
Immunization guidelines
symptomatic child, severe immunosupp:
only the inactivated influenza vaccine (given IM) should be used (yearly)
measles vaccine should NOT be given, (immunoglobulin may be prescribed after measles exposure)
only the inactivated polio vaccine (given IM) should be used
rotavirus vaccine should NOT be given
varicella zoster virus vaccine should NOT be given, immunoglobulin may be prescribed after chicken pox exposure
tetanus immunoglbulin may be rx for tetatnus prone wounds.
HIV children do NOT give vaccines
measles
rotavirus
varicella-zoster
HIV dx tests
ELISA > 18 mo Western blot > 18 mo PCR < 18 mo p24 antigen < 18 mo CD4+ lymph count/ T lymph count b-13 yr
ELISA
> 18mo
determines: response of antibodies to HIV
if found to be + in infacts < 18 mo, indicated only that mother is infected –> maternal antibodies are transmitted transplacentally; use another test
Western blot
> 18 mo
determines: presence of HIV antibodies
if + at only indicates mother is infected
PCR
<18 mo
determines: presence of proviral DNA
very accurate for dx infants 1-4 mo
p24 antigen
<18 mo
determines: HIV antigen specific
very accurate for dx infants 1-4 mo
CD4+ lymphocyte count, T-lymphocyte count
infant - 13 yr
determines: immune system status r/t suppression specifically
age adjustment is essential bc normal counts are relatively high in infants and steadily decline until 6 yrs of age
severe supp in all age groups is < 15% total lymphocytes
<200 cells/L in child 6-12 yr
