HIV in African Children Flashcards
How many children (<15) have HIV?
3.3 million
Mostly in sub saharan Africa
10% of all HIV pts
What is the under 5 mortality including AIDS?
A lot higher
HIV accounts for 35% of deaths in children < 5 yrs in S. Africa
How do kids get HIV?
90% mother to child
Some is child sexual abuse
What are the clinical features of HIV?
Infections e.g. Oral thrush. caries, gingivitis
Progressive Encephalopathy
Enlarged LNs
Severe pneumonia
Clubbing
Herpes Zoster/ VZV
Hepatosplenomegaly
Bruising
Diarrhoea
Molluscum Contagiosum
Skin rashes e.g. scabies, folliculitic rash
Lymphoid interstitial pneumonitis (co inf w/ EBV)
What is this?
Basal ganglia calcification
White matter changes
Atrophy
Vasculopathy / Strokes
What does failure to thrive look like?
What can CMV do in HIV kids?
Sight-threatening retinitis due to co-infection with cytomegalovirus (CMV)
Do kids survive HIV?
Not really if not treated
What proportion will be infected?
①10% or less
②About one third of the infants
③About two thirds of the infants
④More than 75%
About one third of the infants
How does HIV get transmitted vertically?
Breast feeding
Utero
Intrapartum
Maternal viral load increases chance
How does viral load change over time?
A healthy placenta is an effective barrier to transmission of HIV from mother to baby
A healthy placenta is an effective barrier to transmission of HIV from mother to baby
What makes a placenta unhealthy?
Malaria
Toxoplasmosis
Chorioamnionitis
Contractions
Why is the first twin more likely to have HIV?
First baby sweeps the top layer of the birth canal and is more likely to be infected
Does Breastfeeding increase chances of death?
Some increased risk
Risk of HIV transmission must be balanced against risk of increased mortality from formula feeding
How do we reduce HIV?
Contraception advice
Education
Good care
If IMR is > 40 / 1,000 live births, recommend exclusive breast feeding + ARVs for mother or baby [WHO 2010]
What are the WHO guidelines for treatment of breastfeeding women with HIV?
All pregnant and BF women should initiate triple ARVs
- Fixed dose combination Tenofovir+3TC+efavirenz
- BF infants should receive daily NVP for 6 weeks
Maintain ARVs for duration of MTCT risk
Maintain ARVs lifelong with those meeting Rx eligibility (CD4< 500) (strong recommendation)
Maintain ARVs lifelong in all for programmatic reasons (conditional recommendation)
Uninfected infants should exclusively BF for 6 months and continue to BF until atleast 12 months
What drugs exist?
NNRTIs
NRTIs
PIs
InI
How do you treat HIV?
Combination therapy
2 NNRTIs/ 1PI
What are the ADDITIONAL INFLUENCES OF HIV?
- stigma / secrecy
- physical effects of HIV
- growth, puberty, CNS impairments
- ARVs and their toxicities
- sexually transmissible
- risk of rejection
What are challenges in HIV in Africa?
–Severe malnutrition
–Multiple co-infections (especially TB)
–Risk of immune reconstitution inflammatory syndromes (IRIS)
–Family disruption:
- Multiple carers
- Children as caretakers
–Stigmatisation in school
–Depression / Disclosure
–Poverty
- Lack of school fees
- Transport
How do you promote adherence?
Increasing use of peer facilitators who talk about their personal successful experiences.
Does C section halves transmission risk?
Yes
How can cultural change help?
Engagement of the elders involved in the circumcision rituals has successfully generated peer-group pressure to achieve an undetectable viral load prior to participation
How can you give adherence support?
Family based care
Multi-disciplinary teams
Education (HIV / drugs)
Improved formulations
The crucial issue is whether we can deliver ARVs on the scale needed to ensure children can survive to become productive adults. The current aspiration of the HIV policy makers is to produce an AIDS-free generation from 2015 onwards.
The crucial issue is whether we can deliver ARVs on the scale needed to ensure children can survive to become productive adults. The current aspiration of the HIV policy makers is to produce an AIDS-free generation from 2015 onwards.
