MI: HIV in African Children

Question 1

What are some causes of HIV infection in children?

Answer 1

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

Question 2

List some clinical features of HIV infection in children.

Answer 2

• 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)

Question 3

What are some pathophysiological features of HIV encephalopathy?

Answer 3

• Basal ganglia calcification
• White matter changer
• Atrophy
• Vasculpathy/stroke

Question 4

How can HIV be transmitted perinatally?

Answer 4

• In utero
• Intrapartum
• Breastfeeding

Question 5

What is a major risk factor for vertical tranmission?

Answer 5

Maternal plasma viral load

Question 6

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

Answer 6

• 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

Question 7

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

Answer 7

• Healthy placenta

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

Question 8

During which period in pregnancy is transmission most likely?

Answer 8

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

Question 9

State a perinatal risk factor for HIV transmission.

Answer 9

Prolonged rupture of membranes

Question 10

What intervention can reduce HIV transmission intrapartum?

Answer 10

Elective C-section

Question 11

What are the recommendations for breastfeeding and HIV transmission?

Answer 11

• 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

Question 12

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

Answer 12

• 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

Question 13

List some classes (with examples) of antiretroviral drugs.

Answer 13

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

Question 14

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

Answer 14

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

Question 15

List some challenges for HIV treatment in Africa.

Answer 15

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

Question 16

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

Answer 16

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