HIV in African Children Flashcards
How many children under 15 are living with HIV worldwide (2012)
3.3. million
Of the total number of people with HIV worldwide, what proportion are children
1 in 10
What impact does AIDS have on under 5 mortality
A large impact, greatly increases the mortality in this age group
HIV accounts for 35% of deaths in children <5 years in South African
What is the largest form of HIV transmission to children (2)
Mother-to-child transmission is the largest risk factor
However, child sexual abuse or exchanging sex for food/shelter = risk factors for vulnerable children
What are the clinical features of HIV infection (15)
Suppurative ear infection Enlarged parotids Enlarged lymph nodes Enlarged liver and/or spleen Clubbing Herpes zoster infection Progressive encephalopathy Anaemia Frequent nose bleeds Severe oral thrush Failure to thrive Severe pneumonia, TB, LIP, pneumocystis carinii Severe nappy rash Recurrent or persistent diarrhoea Easy bruising
What are two common features of HIV in African children (2)
Chronic bilateral parotid swelling Molluscum contagiosum (especially around the eyes)
What can cause shingles presentation in a child
It is not common - severe immunocompromise is required
What can be seen in neuro-imaging of HIV encephalopathy (4)
Basal ganglia calcification
White matter changes
Atrophy
Vasculopathy/strokes
HIV frequently affects the CNS in children
What are the routes of perinatal infection transmission for HIV (3)
Breast-feeding.
In utero
Intra partum
What is a large risk for mother-child HIV transmission
A large maternal viral load is associated with increased risk of transmission
What is an effective barrier to transmission of HIV from mother to baby
A healthy placenta
What is the risk of vertical transmission from mother-child after ROM
Risk of transmission increased by 2% for every hour post-rupture of membranes
What is the equivalent risk of contracting HIV by drinking 1L of breast milk
Equivalent to one episode of unprotected sex
What is the transmission rate of HIV-1 for every 6 months of breath feeding
4%
HOWEVER, risk of HIV transmission must be balanced against risk of increased mortality from formula feeding in Africa
What are the best approaches to prevent HIV infection in infants (4)
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.
Care and support for HIV infected women, their infants and their families at every stage.
What is the advice regarding ARTs in pregnant/HIV infected mothers
All pregnant and breastfeeding women should initiate triple ARVs
Fixed dose combination tenofovir +3TC+efavirenz.
Breastfeeding mothers should receive daily NVP for 6 weeks.
What are the classes of ARVTs used (4)
Non-nucleoside reverse transcriptase inhibitors
Nucleoside analogues
Nucleotide analogues
Protease inhibitors
What are the three main approaches to HIV therapy (3)
HIV entry
Pretranscriptional
Postranscriptional
What classes of drugs work to prevent HIV cell entry (3)
Fusion inhibitors (enfuvirtide)
CCR5 (coreceptor antagnosits)
Maraviroc (MVC)
What classes of drugs work pretrnacriptionally on HIV (3)
NRTI (zidovudine, lamivudine, didanosine, stavudine, abacavir, emtricitabine)
NtRTI (tenofovir)
NNRTI (nevirapine, efavirenz, etravirine, rilpivirine)
What classes of drugs work postranscriptionall on HIV (2)
Integrase inhibitors (raltegravir, elvitegravir, dolutegravir) PI (lopinavir, ritonavir, fosamprenavir, darunavir, atazanavir, saquinavir, indinavir, tipranavir)
What are the priorities regarding HIV in low and middle income countries (4)
Improved diagnosis, access, formulations, monitoring.
What are the priorities regarding HIV in high income countries (2)
Use of new drugs
Simplification of ART
What are the current recommendations regarding treatment of HIV >5 years
Regardless of clinical symptoms, immune status or viral load - treat
What is triomune junior and baby
ART treatment for young children and babies - come in packs of 60
What are the additional influences of HIV in teenagers (5)
Increased stigma and secrecy Physical effects of HIV (growth, puberty, CNS impairments) ARVs and their toxicities Sexually transmissible Risk of social rejection
What are the challenges of HIV treatment in Africa (7)
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)
What increases ART adherence in children (7)
Peer facilitators to talk about their personal successful experience. Family based care Multi-disciplinary teams Education (HIV/drugs) Improved formulations Pill school SIMPLIFYING TREATMENT
