Clinical Staging Of Pediatric HIV Flashcards
Learn about all the symptoms and signs of HIV in children
Stage 1 Symptoms
Asymptomatic
Generalized Lymphadenopathy
Stage 2 Symptoms
*Unexplained persistent hepato-splenomegaly
*Recurrent oral ulceration
*Unexplained persistent parotid enlargement
*Herpes Zoster
*Recurrent or Chronic URTI - otorrhea, otitis media, sinusitis, tonsillitis
*Fungal nail infection
*Extensive molluscum contagiosum
*Extensive wart virus infection
*Papular pruritic eruption
*Linear gingival erythema
Stage 3 symptoms
*Unexplained persistent diarrhea (>/=14 days)
*Unexplained moderate malnutrition that doesn’t respond to standard therapy
*Unexplained persistent fever (above 37.5 - intermittent or constant, lasts for more than 1 month)
*Persistent oral candidiasis (present after 6 weeks of life)
*Oral hairy leukoplakia
*Lymph node tb
*Pulmonary tb
*Chronic HIV-associated lung disease, including bronchiectasis
*Severe recurrent bacterial pneumonia
*Acute necrotizing ulcerative gingivitis or periodontitis
*Unexplained anemia (<8g/dl), neutropenia (<0.5x 10^9/l) and/or Chronic thrombocytopenia (<50 ×10^9/l)
*Symptomatic lymphoid interstitial pneumonitis
Stage 4 symptoms - infections
The infections
*Pneumocystis (jiroveci) pneumonia
*Recurrent severe bacterial infections (such as empyema, pyomyositis, bone or joint infection, meningitis, but excluding pneumonia)
*Chronic herpes simplex infection (orolabial or cutaneous of more than 1 month’s duration or visceral at any site)
*Cytomegalovirus infection (retinitis or infection of other organs with onset at age more than 1 month)
*Disseminated non-tuberculous myobacterial infection
*Extrapulmonary cryptococcus, including meningitis
Stage 4 signs
*Unexplained severe wasting, stunting or severe malnutrition not responding to standard therapy
*Esophageal candidiasis (or candidiasis of trachea, bronchi or lungs)
*Extrapulmonary TB
*Kaposi Sarcoma
*CNS toxoplasmosis (after neonatal period)
*HIV encephalopathy
*Progressive multifocal leukoencephalopathy
*Chronic cryptosporidiosis (w/ diarrhea)
*Chronic isoporiasis
*Disseminated endemic mycosis (extrapulmonary histoplasmosis, coccidioidomycosis, penicillosis)
*Cerebral or B-cell non-Hodgkin lymphoma
*HIV - associated nephropathy or cardiomyopathy
HIV Testing for general population - HIV Positive
Reactive to First Response, Oraquick HIV 1&2 and SD Bioline - HIV Positive.
If First response was reactive but non-reactive to oraquick, repeat both sequentially. If reactive to all, confirm with SD Bioline - HIV Positive if all reactive, HIV inconclusive if SD Bioline unreactive
HIV Testing for General Population - HIV Inconclusive
Reactive to First Response and Oraquick, but not reactive to SD Bioline
HIV Testing for General Population - HIV Negative
Reactive to First Response but not reactive to Oraquick (after repeating tests) - HIV negative
If non reactive to First response - HIV negative.
Note: Newly diagnosed with HIV should be retested to verify their status before they are started on ART.
Early Infant Prophylaxis and Diagnosis (Step 1-4)
HIV Exposed infant - Provide 12 weeks prophylaxis with zidovudine and nevirapine within 24 hours of birth. Then take dried blood spot sample within first 6 weeks of life and start septrin at 6 weeks. DBS + - Start prophylaxis, ART. DBS negative - Take DBS sample at 9 months
Early Infant Prophylaxis and Diagnosis (Step 5-7
If DBS Positive at 9 months - Start ART. If not positive - Do antibody test at 18 months. If antibody test positive at 18 months, child start ART. If not and the child was weaned >/= 12 weeks before test, child not infected. Stop septrin.
Early infant prophylaxis and diagnosis - Final steps
If the antibody test is negative and the child wasn’t weaned >/= 12 weeks before the test, retest 12 weeks after complete cessation of feeding. If positive, child starts ART. If negative, child not infected, stop septrin.
