HIV

Question 1

Number of children with hiv

Answer 1

3.2 million, 2.9 million in subsaharan Africa

Question 2

Estimated number of deaths from AIDS per year in these children?

Answer 2

190 000

Question 3

What proportion of children born with HIV die within their first year of life and second year without treatment?

Answer 3

1/3 and 1/2

Question 4

How do you reduce HIV-related mortality in children by 75%?

Answer 4

By initiating antiviral therapy before the 12th week of life.

Question 5

Why are children and pregnant women living with HIV left behind? 4 main reasons.

Answer 5

1. Limited access to sexual and reproductive health and HIV services.
2. Limited access to HIV-treatment
3. Failure to prioritize children
4. Poorly integrated health-care services

Question 6

Do children with HIV receive antiviral therapy to the same extent as adults?

Answer 6

No. Children are 1/3 less likely to receive therapy.

Question 7

Maternal risk factors for mother-child transmission of HIV?

Answer 7

1. Viral load - strongest predictor
2. Symptoms
   3- CD4 count

Question 8

Child risk factors for mother-child transmission of HIV?

Answer 8

1. Prematurity = higher risk

2. Genetic factors

Question 9

Other risk factors for mother-child transmission of HIV?

Answer 9

1. Means of delivery, the more trauma the higher risk.
2. Time from amniotic retirement
3. The amount and type of the HIV-virus

Question 10

Risk of in utero transmission? without treatment.

Answer 10

Less than 20%. Can vary depending on the type of virus.

Question 11

Risk of transmission during vaginal delivery?

Answer 11

80%

Question 12

Risk of transmission during breastfeeding?

Answer 12

10-15%

Question 13

How can you decrease the risk of transmission to 1%

Answer 13

1. optimal ART treatment during pregnancy.
2. Elective sectio (week 38)
   (3. IV treatment during delivery or sectio if HIV RNA >50 or prematurity)
3. optimal treatment of the child for 4 weeks.
4. No breast feeding

Question 14

Clinical findings which may suggest HIV infection in children?

Answer 14

1. Protracted oral candidosis

2. Parotitis/swelling of parotis

Question 15

Laboratory findings which may suggest HIV infection?

Answer 15

1. Hypergammaglobulinemia

2. Lowered CD4% count

Question 16

When is ART recommended?

Answer 16

All infants with verified HIV infection should be treated with 3 active antivirals. However, early start of treatment may prevent the development of antibodies and thus regular HIV-tests may be negative in spite of infection.

Question 17

When is the risk for HIV-transmission negligible?

Answer 17

With optimal treatment and HIV-RNA

Question 18

What is hairy leukoplakia?

Answer 18

White patch on the side of the tongue with a corrugated or hairy appearance. Caused by EBV in immunocompromised patients, such as HIV/AIDS.

Question 19

What is Kaposi’s sarcoma?

Answer 19

Tumour caused by the HHV8. Most commonly appears early on the toes and soles as reddish, violaceous, or bluish-black macules and patches that spread and coalesce to form nodules or plaques.
One of the AIDS defining diseases.

Question 20

What is PML?

Answer 20

Progressive multifocal leukoencephalopati. Caused by JC-virus in the immunocompromised.

Question 21

What is toxoplasmosis?

Answer 21

Infection caused by toxoplasma gondii. Usually asymptomatic in adults. Can cause severe disease in the immunocompromised, seizures due to cerebral lesions.

Question 22

Varför måste man ALLTID behandla opportunistic infections innan man påbörjar ART?

Answer 22

För annars kan man få immune reconstitution inflammatory syndrome (IRIS) där immunförsvaret börjar återhämta sig o överreagerar på opp infektionen.