HIV in African children Flashcards
epidemiology of HIV in children
sub-saharan Africa has the most
also alot in Asia
of the 35.3 million people with HIV - 1 in 10 are children
effect of HIV on death rates
massive contribution of HIV to deaths
improvements in child health statistics were erradicated as part of HIV epidemic
HIV acounts for 35% of deaths <5 yrs in South Africa
Trend is increasing towards deaths in teenagers that were perinatally effected and did not present until teenager
how are children getting infected
vertical transmission
child sexual abuse or exchanging sex for food/shelter = risk factors for vul children
clincial features of HIV
effects every organ because of the immunodeficiency
severe failure to thrive
what signs of HIV does this child have
molluscum - not usually on face
swelling of parotids
sign of HIV here
lymphadenopathy
sign of HIV
skin rash - folliculitic
has a lot of ddx
sign of HIV here
oral thrush
can extend down oesophagus -> oesophagitis -> painful to swallow -> malnutrition
sign of HIV here
gingivitis
URTI
sinusitis
otitis media
This could be mistaken for TB
but if the pt is well in themselves - more likely lymphoid interstitial pneumonitis
co-infection with EBV
in progressive disease - get lymphoid tissue - as tissue regresses between the lungs, the lung tissue stretches -> bronchiectasis, chronic suppurative lung disease and clubbing
HIV sign here
POTs disease - TB of the spine
Effect of HIV on other common illnesses
dont have T cell immunity - get much worse illness
eg shingles in >1 dermatome or in trigeminal nerve
chicken pox pneumonitis
out of control molluscum around eye
HIV in the brain
in 1st 2 yr of life brain make the neuronal connections
if lesions with neurotropic virus at this point -> long term consequences: pic
stroke - immune activation and inflammatory changes in the vascular endothelium
signs of HIV here
submandibular abscess
lymophadenopathy
hepatosplenomegaly
adenopathy in groin
weak
signs of HIV here
on ventilater
ET tube
subclavian line
pneumocystis pneumonia
high mortality
sign of HIV here
blind because of co-infection with CMV
sight threatening retinitis
Sign of HIV here
lesion inside the mouth - Kaposi sarcoma
due to coinfection with HHV8
survival chart and classification for HIV pre-HAART for european children
A - mild eg lymphadenopathy
C - AIDS defining illness
by 6yrs 20% were dead
survival chart and classification for HIV pre-HAART for African children
80% dead by 3
if get AIDS defining illness - dont survive for any time
Born to HIV +ve mothers with no treatment (vaginally) what proporion of babies affected
At population level 1/3 are infected
others are affected eg orphaned -> commercial sex etc and vulnerable to infection
how can HIV be passed to baby
breast feeding
in utero
intra partum
maternal plasma viral load is a major risk factor - very unlikely to transmit if undetectable
pattern of viraemia in HIV infected adult
initial peak at 10(6) - immune response bring down to some control - bring the level down
then immune escape - as virus outwits immune defence
increase viral load
so can have uneffected children in the point where the viral load is low
How does HIV pass in utero
healthy placenta is a barrier
but unhealthy is not: malaria, toxoplasmosis, chorioamnionitis
most transmission is at end of pregnancy when placenta is getting tired, and have maternal contraction -> microhaemorrhage of maternal blood into fetus.
if twins - likely that both will be infected or both wont. can get cases where only one is infected - first born twin more risk, this is the one sitting in birth canal for longer, and if ascending infection - baby is swallowing fluid.
Prolonged rupture of membranes = increased transmission
benefit of ELCS in HIV untreated mums
halves rate of transmission
