HIV

Question 1

Steps to diagnose

Answer 1

1. Proper counselling
2. Diagnose HIV exposure - mom
3. Diagnose HIV infection in child
   < 18 months: HIV PCR
   > 18 months: HIV Rapid/HIV ELISA
4. Confirm infection in the child
   < 18 months: 2nd HIV PCR
   > 18 months: Confirm Rapid/ ELISA
5. HIV disease classification
   CD4 cell count
   Symptomatic classification - WHO/CDC

Question 2

Treatment in < 3 years or < 10kg

Answer 2

ABC + 3TC +LPV/r

Question 3

Treatment in 3-10 years and > 10kg

Adolescents 10-15 years and < 40kg

Answer 3

ABC + 3TC + EFV

Question 4

Treatment >/= 40kg and age >/= 15 years

Answer 4

TDF + 3TC/FTC + EFV

Question 5

Side Effects

Answer 5

Tenofovir - nephrotoxic and decrease bone mineral density
ABC - hypersensitivity
3TC - pancreatitis
LPV - hepatic toxicity, diarrhoea, nausea
EFV - strange dreams, rash, teratogenic

Question 6

IRIS

Answer 6

immune reconstitution inflammatory syndrome
HIV + on treatment
CD4 count going up
viral load going down
child still not better - with new signs and symptoms
due to underlying opportunistic infection that the body is now reacting to - most common CMV + TB
unmasking IRIS
paradoxical IRIS - knew about underlying disease

Question 7

HIV encephalopathy

Answer 7

known HIV +
UMN and long tract signs
microcephalus - brain is not growing
developmental delay - regression milestones