MI: HIV in African Children Flashcards

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1
Q

What are some causes of HIV infection in children?

A
  • Mother-to-child transmission (90%)
  • Child sexual abuse
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2
Q

List some clinical features of HIV infection in children.

A
  • Chronic swelling of the parotid glands
  • Molluscum contagiosum
  • Lymphadenopathy
  • Dental caries, gingivitis and respiratory infection
  • Lymphoid interstitial pneumonitis (lung condition characterised by lymphoproliferation due to immune activation)
  • Shingles
  • HIV encephalopathy
  • Severe failure to thrive
  • CMV coinfection (can cause sight-threatening retinitis)
  • Kaposi sarcoma (caused by HHV8)
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3
Q

What are some features of HIV encephalopathy?

A
  • Basal ganglia calcification
  • White matter changer
  • Atrophy
  • Vasculpathy/stroke
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4
Q

How can HIV be transmitted perinatally?

A
  • In utero
  • Intrapartum
  • Breastfeeding
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5
Q

What is a major risk factor for vertical tranmission?

A

Maternal plasma viral load

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6
Q

Describe the pattern of viraemia in an HIV-affected adult.

A
  • You will get a burst of viraemia soon after being infected
  • This will then be brought under control by the cellular and humoral immune responses
  • Later on, there will be immune escape where the virus overcomes immune defences leading to an increase in viral load

NOTE: if the mother acquires HIV during or immediately before pregnancy, they are at high risk of transmission to the baby

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7
Q

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

A
  • Healthy placenta

NOTE: there are conditions that can damage the placenta (e.g. malaria, toxoplasmosis)

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8
Q

During which period in pregnancy is transmission most likely?

A

End of pregnancy (the placenta becomes less effective as a barrier)

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9
Q

State a perinatal risk factor for HIV transmission.

A

Prolonged rupture of membranes

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10
Q

What intervention can reduce HIV transmission intrapartum?

A

Elective C-section

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11
Q

What are the recommendations for breastfeeding and HIV transmission?

A
  • Breastfeeding should be avoided if a safe alternative (i.e. formula) is available
  • In some developing countries, the risk of diarrhoea from avoiding breastfeeding may outweight the risk of HIV transmission from breastfeeding
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12
Q

Outline the WHO comprehensive approach to prevent HIV infection in infants.

A
  • Prevention of HIV in parents to be
  • Prevention of unintended pregnancies in HIV-positive women
  • Prevention of transmission from an HIV-infected mother to the baby
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13
Q

List some classes (with examples) of antiretroviral drugs.

A
  • NRTI (e.g. zidovudine)
  • NNRTI (e.g. efavirenz)
  • Integrase inhibitors (e.g. raltegravir)
  • Protease inhibitors (e.g. lopinavir)
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14
Q

List the research priorities for HIV in developed and developing countries.

A

High income countries:

  • Highly individualised care
  • Simplifying treatment
  • Investigating new drugs

Developing countries with high HIV burden:

  • Improving access to treatment
  • Improving diagnosis
  • Improving formulations
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15
Q

List some challenges for HIV treatment in Africa.

A
  • Malnutrition
  • Co-infection (especially TB)
  • Risk of immune reconstitution inflammatory syndrome (IRIS)
  • Family disruption
  • Stigma
  • Depression
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16
Q

List some ways in which adherence to ART has been promoted in Africa.

A
  • Peer-facilitators
  • Improved formulations and education
  • Simplifying treatment