HIV in African Children Flashcards

1
Q

How many children under the age of 15 have HIV?

A

3.3 million (3.0 – 3.7 million)

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2
Q

What proportion of people with HIV are children?

A

1 in 10 are children

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3
Q

What proportion of deaths in children are as a result of HIV?

A

HIV accounts for 35% of deaths in children < 5 yrs in S. Africa.

Trend however is towards increasing proportion of deaths in TEENAGERS with perinatally acquired HIV.

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4
Q

What are causes of HIV in children?

A

90% due to mother-to-child transmission.

But child sexual abuse or exchanging sex for food/shelter are significant risk factors for vulnerable children.

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5
Q

What is this?

A

A very common feature of HIV in African children - chronic bilateral parotid swelling, and molluscum..

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6
Q

What is this?

A

Dramatic lymphadenopathy - sign of immune activation following HIV infection - likely to be accompanied by hepatosplenomegaly and lymphoid interstitial pneumonitis (LIP).

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7
Q

What is this?

A

Skin rashes are common - this is a typical extensive folliculitic rash, but some of the lesions may be insect bites. Scabies can be extensive and atypical - in advanced HIV infection it may not be itchy, since this require a host response to the mite faeces.

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8
Q

What is this?

A

Oral candidiasis - may be associated with oesophageal candidiasis, resulting in pain on swallowing, poor feeding, weight loss.

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9
Q

What is this?

A

Severe dental caries and frequent upper respiratory tract infections are common.

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10
Q

What is this?

A

Lymphoid interstitial pneumonitis - also illustrating how impossible it is to distinguish this condition from TB radiologically.

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11
Q

What is this?

A

Clubbing - not seen with uncomplicated TB or LIP. Suggests bronchiectasis with chronic lower respiratory tract infection may have occurred in the wake of LIP.

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12
Q

What is this?

A

TB Spine - Pott’s Disease

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13
Q

What is this?

A

Primary varicella zoster infection (chicken pox) complicated by pneumonitis.

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14
Q

What is this?

A

More common manifestation of VZV infection = multidermatomal zoster (shingles).

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15
Q

What is this?

A

Molluscum contagiosum

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16
Q

What is this?

A

Neuro-imaging of HIV Encephalopathy:

  • Basal ganglia calcification
  • White matter changes
  • Atrophy
  • Vasculopathy/Strokes
17
Q

What is this?

A

Pneumocystis jiroveci pneumonia in a 3 month old infant

18
Q

What is this?

A

Left Eye

Sight-threatening retinitis due to co-infection with cytomegalovirus (CMV).

19
Q

What is this?

A

Oral Kaposi’s sarcoma

20
Q

What proportion will be infected if mother has HIV?

A. 10% or less

B. About one third of the infants

C. About two thirds of the infants

D. More than 75%

A

B. About one third of the infants - generally

C. About two thirds of the infants - if mother has high viral load

21
Q

How can HIV be transmitted perinatally?

A

Through breast feeding

In utero

Intra partum

22
Q

What is a major risk factor for vertical transmission?

A

Maternal plasma viral load

23
Q

Why can a mother have one child with HIV, a couple without HIV and then have another child with HIV years later?

A

Natural timecourse of illness - high viral load, natural suppression, overwhelmed immune system.

24
Q

What acts as a barrier betwen mother and child for HIV?

A

Placenta

25
Q

Which twin is more likely to get HIV?

A

First born twin is more likely to get HIV because they are in birth canal for longer.

Also prolonged delivery.

26
Q

What is the association between risk of transmission and duration of rupture of membranes?

A

Risk of MTCT increases by 2% for every hour post-rupture of membranes.

27
Q

What is the association between C-section and transmission risk?

A

C-section halves transmission risk

28
Q

What is the association between formula feeding and HIV risk?

A

No further transmission in formula fed advice. However, low adherence to formula fed.

Risk from drinking 1 litre of breast milk = Risk from one episode of unprotected sex.

29
Q

How can interventions reduce the risk of transmission?

A

None: 25 - 40%

Avoid B/F: 12 - 25%

AZT mono Rx: 6 - 8%

ELCS + AZT mono: < 2%

Combo Rx (VL < 50): << 1%

30
Q

What is the comprehensive approach to prevent HIV infection in infants?

A

Care and support for HIV-infected women, their infants and their families.

  • Prevention of HIV in parents to be.
  • Prevention of unintended pregnancies among HIV-infected women.
  • Prevention of transmission from an HIV-infected woman to her infant.
31
Q

Which antiretroviral drug classes are focused on preventing HIV entry?

A

Fusion Inhibitors: Enfuvirtide (T-20)

CCR5 coreceptor antagonists: Maraviroc (MVC)

32
Q

Which antiretroviral drug classes are pre-transcriptional?

A

NRTI:

  • Zidovudine (ZDV)
  • Lamivudine (3TC)
  • Didanosine (ddI)
  • Stavudine (d4T)
  • Abacavir (ABC)
  • Emtricitabine (FTC)

NtRTI:

  • Tenofovir (TDF)

NNRTI:

  • Nevirapine (NVP)
  • Efavirenz (EFV)
  • Etravirine
  • Rilpivirine
33
Q

Which antiretroviral drug classes are post-transcriptional?

A

Integrase inhibitors:

  • Raltegravir
  • Elvitegravir
  • Dolutegravir

PI:

  • Lopinavir (LPV)
  • Ritonavir (RTV)
  • Fosamprenavir
  • Darunavir (DRV)
  • Atazanavir (ATZ)
  • Saquinavir (SQV)
  • Indinavir (IDV)
  • Tipranavir (TPV)
34
Q

What are some challenges associated with preventing HIV in children?

A
  • 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 and transport