HIV in African Children

Question 1

How many children under 15 are living with HIV worldwide (2012)

Answer 1

3.3. million

Question 2

Of the total number of people with HIV worldwide, what proportion are children

Answer 2

1 in 10

Question 3

What impact does AIDS have on under 5 mortality

Answer 3

A large impact, greatly increases the mortality in this age group
HIV accounts for 35% of deaths in children <5 years in South African

Question 4

What is the largest form of HIV transmission to children (2)

Answer 4

Mother-to-child transmission is the largest risk factor

However, child sexual abuse or exchanging sex for food/shelter = risk factors for vulnerable children

Question 5

What are the clinical features of HIV infection (15)

Answer 5

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

Question 6

What are two common features of HIV in African children (2)

Answer 6

Chronic bilateral parotid swelling 
Molluscum contagiosum (especially around the eyes)

Question 7

What can cause shingles presentation in a child

Answer 7

It is not common - severe immunocompromise is required

Question 8

What can be seen in neuro-imaging of HIV encephalopathy (4)

Answer 8

Basal ganglia calcification
White matter changes
Atrophy
Vasculopathy/strokes

HIV frequently affects the CNS in children

Question 9

What are the routes of perinatal infection transmission for HIV (3)

Answer 9

Breast-feeding.
In utero
Intra partum

Question 10

What is a large risk for mother-child HIV transmission

Answer 10

A large maternal viral load is associated with increased risk of transmission

Question 11

What is an effective barrier to transmission of HIV from mother to baby

Answer 11

A healthy placenta

Question 12

What is the risk of vertical transmission from mother-child after ROM

Answer 12

Risk of transmission increased by 2% for every hour post-rupture of membranes

Question 13

What is the equivalent risk of contracting HIV by drinking 1L of breast milk

Answer 13

Equivalent to one episode of unprotected sex

Question 14

What is the transmission rate of HIV-1 for every 6 months of breath feeding

Answer 14

4%

HOWEVER, risk of HIV transmission must be balanced against risk of increased mortality from formula feeding in Africa

Question 15

What are the best approaches to prevent HIV infection in infants (4)

Answer 15

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.

Question 16

What is the advice regarding ARTs in pregnant/HIV infected mothers

Answer 16

All pregnant and breastfeeding women should initiate triple ARVs
Fixed dose combination tenofovir +3TC+efavirenz.
Breastfeeding mothers should receive daily NVP for 6 weeks.

Question 17

What are the classes of ARVTs used (4)

Answer 17

Non-nucleoside reverse transcriptase inhibitors
Nucleoside analogues
Nucleotide analogues
Protease inhibitors

Question 18

What are the three main approaches to HIV therapy (3)

Answer 18

HIV entry
Pretranscriptional
Postranscriptional

Question 19

What classes of drugs work to prevent HIV cell entry (3)

Answer 19

Fusion inhibitors (enfuvirtide)
CCR5 (coreceptor antagnosits)
Maraviroc (MVC)

Question 20

What classes of drugs work pretrnacriptionally on HIV (3)

Answer 20

NRTI (zidovudine, lamivudine, didanosine, stavudine, abacavir, emtricitabine)
NtRTI (tenofovir)
NNRTI (nevirapine, efavirenz, etravirine, rilpivirine)

Question 21

What classes of drugs work postranscriptionall on HIV (2)

Answer 21

Integrase inhibitors (raltegravir, elvitegravir, dolutegravir)
PI (lopinavir, ritonavir, fosamprenavir, darunavir, atazanavir, saquinavir, indinavir, tipranavir)

Question 22

What are the priorities regarding HIV in low and middle income countries (4)

Answer 22

Improved diagnosis, access, formulations, monitoring.

Question 23

What are the priorities regarding HIV in high income countries (2)

Answer 23

Use of new drugs

Simplification of ART

Question 24

What are the current recommendations regarding treatment of HIV >5 years

Answer 24

Regardless of clinical symptoms, immune status or viral load - treat

Question 25

What is triomune junior and baby

Answer 25

ART treatment for young children and babies - come in packs of 60

Question 26

What are the additional influences of HIV in teenagers (5)

Answer 26

Increased stigma and secrecy 
Physical effects of HIV (growth, puberty, CNS impairments)
ARVs and their toxicities
Sexually transmissible 
Risk of social rejection

Question 27

What are the challenges of HIV treatment in Africa (7)

Answer 27

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)

Question 28

What increases ART adherence in children (7)

Answer 28

Peer facilitators to talk about their personal successful experience. 
Family based care
Multi-disciplinary teams 
Education (HIV/drugs)
Improved formulations 
Pill school 
SIMPLIFYING TREATMENT