MI: HIV in African Children Flashcards
What are some causes of HIV infection in children?
- Mother-to-child transmission (90%)
- Child sexual abuse
List some clinical features of HIV infection in children.
- Chronic swelling of the parotid glands
- Molluscum contagiosum - on face
- Lymphadenopathy
- Dental caries, gingivitis and upper respiratory infection
- Oral thrush –> can spread down oesophagus
- Lymphoid interstitial pneumonitis (lung condition characterised by lymphoproliferation due to immune activation, can cause bronchiectasis –> clubbing)
- Shingles - if in >1 dermatome, or in eye
- HIV encephalopathy
- Hepatomeglay, splenomegaly
- Severe failure to thrive
- CMV coinfection (can cause sight-threatening retinitis)
- Herpes
- Kaposi sarcoma (caused by HHV8)
every organ affected due to immunodeficiency
What are some features of HIV encephalopathy?
- Basal ganglia calcification
- White matter changer
- Atrophy (makes ventricles large)
- Vasculopathy/stroke
How can HIV be transmitted perinatally?
- In utero
- Intrapartum
- Breastfeeding
What is a major risk factor for vertical tranmission?
Maternal plasma viral load
Describe the pattern of viraemia in an HIV-affected adult.
- 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
What is a natural effective barrier to HIV transmission from mother to baby?
- Healthy placenta
NOTE: there are conditions that can damage the placenta (e.g. malaria, toxoplasmosis)
During which period in pregnancy is transmission most likely?
End of pregnancy (the placenta becomes less effective as a barrier)
State a perinatal risk factor for HIV transmission.
Prolonged rupture of membranes
What mode of delivery can reduce HIV transmission?
Elective C-section
What are the recommendations for breastfeeding and HIV transmission?
- 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
drinking 1 litre of breastmilk = risk from 1 episode of unprotected sex
Outline the WHO comprehensive approach to prevent HIV infection in infants.
- 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
List some classes (with examples) of antiretroviral drugs.
- NRTI - Nucleoside reverse transcriptase inhibitors (e.g. zidovudine)
- NNRTI - Non nucleoside reverse transcriptase inhibitors(e.g. efavirenz)
- Integrase inhibitors (e.g. raltegravir)
- Protease inhibitors (e.g. lopinavir)
List the research priorities for HIV in developed and developing countries.
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
List some challenges for HIV treatment in Africa.
- Malnutrition
- Co-infection (especially TB)
- Risk of immune reconstitution inflammatory syndrome (IRIS)
- Family disruption
- Stigma
- Depression
