HIV in African children Flashcards
rank these regions in order of number of Children (<15 years) living with HIV 2012 from highest to lowest
Caribbean S+SE Asia SS Africa Middle East + N africa Latin America
SS Africa
S+ SE Asia
Latin America
Middle East + N africa
Caribbean
HIV accounts for __% of deaths in children < 5 yrs in S. Africa
35
HIV in children: > 90% due to ____ transmission?
mother-to-child
clinical features of HIV in kids?
mmemonic?
FAST:
Failure to thrive
Anaemia
Severe pneumonia
TB
Enlarged lymph nodes
Enlarged liver/spleen
A 3 y/o child presents with severe nappy rash, recurrent diarrhoea and easy bruising.
O/E he has Chronic bilateral parotid swelling, and molluscum on his face.
Possible ddx?
HIV - these are all symptoms
A very common feature of HIV in African children - chronic bilateral parotid swelling, and molluscum
a 1y/0 presents with in pain on swallowing, poor feeding, weight loss.
his mother has hiv .
possible ddx?
Oral candidiasis
name one benign lymphoproliferative disorder characterised by lymphocyte predominant infiltration of the lungs, that is common in kids with HIV?
Lymphocytic interstitial pneumonitis - LIP
Lymphocytic interstitial pneumonitisis hard to distinguish from?
TB
how does vxv commonly present in kids with hiv?
chicken pox complicated with pneumonitis
shingles - Multidermatomal!
the following are present in which complication of HIV?
Basal ganglia calcification
White matter changes
Atrophy
Vasculopathy / Strokes
HIV Encephalopathy
Kaposi sarcoma is associated with co-infection with which virus?
HHV8
Coinfection with which virus (which is transmitted perinatally) usually causes no consequences but can cause sight-threatening retinitis?
CMV
What is the major risk factor for Mother To Child Transmission?
Maternal plasma viral load
what is the pattern of viraemia in HIV infected adult?
Initial peak - millions of copies
Set point - 10^3 - 10^5 /ml
Late disease - peak similar to first stage
can a foetus contract HIV intrapartum?
No
A healthy placenta is an effective barrier to transmission of HIV from mother to baby
Risk of MTCT increases by 2% for every hour post ?
rupture of membranes
Breast Feeding increases risk of transmission by how much compared to formula feeding?
16%
Breast Feeding increases risk of transmission compared to formula feeding. But what are the caveats with formula feeding?
increased mortality risk 20%
WHO recommends that if infant mortality rate > 40/1000 live births, recommend what in terms of feeding the baby?
§ Exclusive breastfeeding
§ ARVs for mother OR baby
sounds crazy but: only 4% transmission of HIV-1 for ever y6 months
Why can some people be infected with HIV but not affected?
There is a small subset known as HIV elite controllers.
They are able to spontaneously control viral replication to almost undetectable levels for many years without cART
zidovudine is what drug class?
nucleoSide reverse transcriptase inhibitors - NRTIs
Tenofovir is what drug class?
nucleoTide reverse transcriptase inhibitor - NRTI
List measures adopted to reduce Vertical transmission of HIV?
in order of mortality:
None 25 - 40%
Avoid BreastFeed 12 - 25%
Zidovudine mono Rx 6 - 8%
elite controllers + AZT mono < 2%
WHO recommended measures adopted to reduce Vertical transmission of HIV?
All pregnant and BF women should initiate triple ARVs:
Fixed dose combination Tenofovir+ Lamivudine+efavirenz
BF infants should receive daily nevirapine for 6 weeks
