MICRO: HIV in African children Flashcards
Where do most cases of HIV in children occur?
The vast majority of cases occur in Sub-Saharan Africa (2.9m out of a total of ~3.3m)
Why is HIV in children a large burden? What is the cause of most HIV in children?
1 in 10 of all cases occur in children
HIV accounts for 35% of deaths in children <5 years old
90% caused by MTCT (others by sexual abuse)
What is an early facial feature in HIV infected children?
- Chronic bilateral parotid swelling
- with molluscum contagiosum
= early indication of HIV infection (inc. failure to thrive)
Why does lymphoid interstitial pneumonitis occur in HIV in children? What are the other clinical features of this? What does LIP resemble on CXR?
LIP (lymphoid interstitial pneumonitis)
- Characterised by lymphoproliferation due to immune activation
- If lymphoid tissue contracts –> bronchiectasis and chronic suppurative lung pathology
- Subsequently causes clubbing
Indistinguishable from TB on CXR
What skin features/infections are common in HIV in children?
- Molluscum on face
- Dental caries and gingivitis
- Scabies (but may not be itchy as this requires immune activation)
- Shingles
- Kaposi’s sarcoma (HHV8)
What organ enlargement can occur in HIV in children?
- Parotid swelling
- Lymphadenopathy
- Hepato-spleno-megaly
What respiratory infections may occur in HIV in children?
TB(looks like LIP on CXR)
PCP pneumonia
URTIs
What neurolgical conditions may occur in HIV in children?
PML/progressive multifocal leukoencephalopathy (JC virus infects oligodendrocytes)
CMV retinitis (“white cotton wool exudates” in eyes)
Failure to thrive is also seen
How common is perinatal transmission of HIV? What are the modes of transmission?
- About 1/3rd of infants have transmission from the mother
- HIV can be transmitted perinatally through:
- Breast feeding
- In utero
- Intra-partum (i.e. when giving birth)
What is the single biggest risk factor for perinatal transmission?
Maternal viral load - if maternal viral load is >100,000 and there is no intervention then two-thirds of babies would acquire HIV perinatally.
In terms of the mother’s time of infection with HIV, when is risk to the baby highest?
If the mother acquires HIV during or just before pregnancy, they are at high risk of transmitting it to the baby
Is the placenta an effective barrier to transmission of HIV?
Yes BUT ONLY IF IT IS HEALTHY i.e. no malaria, no toxoplasmosis,.
At what time point does most perinatal HIV transmission occur?
Most transmission tends to occur towards the end of pregnancy (placenta not as good)