HIV in children Flashcards
Standard of care for perinatal HIV infection
- all pregnant women receive counseling and testing for HIV early in pregnancy
- repeat testing for all high-risk HIV-negative women
- rapid HIV test intrapartum for HIV-unknown so intrapartum antiretrovirals can be given
- consider C-section to prevent transmission to baby
what is the most common test for HIV
antibody test ELISA and confirmed by Western blot
Best test for HIV
HIV DNA PCR
Confirmation or alternative testing for HIV
HIV RNA assay for viral load
In a baby when should antibody retesting be done
after 18 months of age
HIV medication for exposed infants
Zidovudine 2mg/kg/dose 4 x day within 8-12 hours after birth and continue for 6 weeks
HIV medication for exposed infants whose mothers were not on therapy
Zidovudine and Nevirapine
What is the landmark study on HIV and what did it show
ACTG 076 study on HIV-positive mothers and their infants.
Shows untreated mothers had 25.5% chance of vertical transmission, and mother/baby treatments had 8.3% rate of transmission.
multiple med regiments has reduced rate to <2%
What condition has high mortality rate in HIV-positive infants
pneumocystic pneumonia (PCP)
What prophylaxis should be started on all infants born to HIV-positive mothers
Pneumocystic pneumonia at 6 weeks and take until HIV is ruled out completely
Important points to remember about HIV in infants
- mom can test negative
2. mom may have had “bad flu” that was actually HIV Infection
Risk factors for HIV in infants
- Chlamydia
- hepatitis C positive
- clinic hoping
What symptoms are common in HIV-positive children
- FTT
2. irritability
Symptoms of HIV during first 6 weeks of life
usually asymptomatic
first symptoms in pediatric patients with HIV
first - lymphadenopath 2. enlarged liver and spleen 3. FTT 4. encephalopathy 5 low birth weight
What symptoms of HIV in pediatric patients develop over time
- diarrhea
- pneumonia
- thrush
- opportunistic infections
complications that can develop in pediatric patients with HIV
- cardiac hypertrophy/CHF
- anemia
- malignancies
what percent of untreated HIV-positive infants will die by age 4
15-20%
80% of HIV-positive infants will have symptoms by what age
12 months
Management of HIV-positive child
- comanage with HIV specialist
- antiretroviral meds based on CD4 count and clinical manifestation
- monitor for opportunistic/bacterial infection/malignancies
- vaccinate for flu/ live viruses risky
Lab monitoring for pediatric patient with HIV
- use CD4 % test for child under 5 years
- check CD4 % every 3-4 months
- check HIV RNA {viral load} every 3-4 months
What children have highest risk of HIV progression
children under 1 year;
children > 5 years are comparable to adults
What are the goals to antiretroviral therapy
- reduce plasma HIV RNA to below detectable level
- normalize immune status
- reduce HIV-related mortality and morbidity
- restore/preserve immune function
- suppress viral replication
- maintain normal growth and cognitive development
- minimize drug-related toxicity
- optimize QOL
strategies for HIV treatment in peds
- use combo agents {3 drugs from at least 2 categories}
2. maximize adherence
choice of HIV medications are based on
- HIV type
- future treatment options
- drug resistance and cross-resistance
side effects of HIV meds should prompt what
reevaluation of antiretroviral regimen
Common side effects of antiretroviral medications: hematologic
drug-induced bone marrow suppression
Common side effects of antiretroviral medications: mitochondrial dysfunction
- lactic acidosis
- hepatic toxicity
- pancreatitis
Other common side effects of antiretroviral meds
- lipodystrophy
2. metabolic abnormalities
Why should a care provider not reduce drug doses of HIV meds
risk of drug resistance
Two cohorts of adolescents with HIV
- those with perinatal exposure
2. those newly infected
Important points about antiretrovirals and contraception
always use but know that they may interact with antiretrovirals
