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a path 3 > MICRO: HIV in African children > Flashcards

MICRO: HIV in African children Flashcards

1
Q

Where do most cases of HIV in children occur?

A

The vast majority of cases occur in Sub-Saharan Africa (2.9m out of a total of ~3.3m)

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2
Q

Why is HIV in children a large burden? What is the cause of most HIV in children?

A

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)

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3
Q

What is an early facial feature in HIV infected children?

A
  • Chronic bilateral parotid swelling
  • with molluscum contagiosum

= early indication of HIV infection (inc. failure to thrive)

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4
Q

Why does lymphoid interstitial pneumonitis occur in HIV in children? What are the other clinical features of this? What does LIP resemble on CXR?

A

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

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5
Q

What skin features/infections are common in HIV in children?

A
  • Molluscum on face
  • Dental caries and gingivitis
  • Scabies (but may not be itchy as this requires immune activation)
  • Shingles
  • Kaposi’s sarcoma (HHV8)
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6
Q

What organ enlargement can occur in HIV in children?

A
  • Parotid swelling
  • Lymphadenopathy
  • Hepato-spleno-megaly
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7
Q

What respiratory infections may occur in HIV in children?

A

TB(looks like LIP on CXR)

PCP pneumonia

URTIs

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8
Q

What neurolgical conditions may occur in HIV in children?

A

PML/progressive multifocal leukoencephalopathy (JC virus infects oligodendrocytes)

CMV retinitis (“white cotton wool exudates” in eyes)

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9
Q

Failure to thrive is also seen

A
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10
Q
A
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11
Q

How common is perinatal transmission of HIV? What are the modes of transmission?

A
  • About 1/3rd of infants have transmission from the mother
  • HIV can be transmitted perinatally through:
    1. Breast feeding
    2. In utero
    3. Intra-partum (i.e. when giving birth)
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12
Q

What is the single biggest risk factor for perinatal transmission?

A

Maternal viral load - if maternal viral load is >100,000 and there is no intervention then two-thirds of babies would acquire HIV perinatally.

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13
Q

In terms of the mother’s time of infection with HIV, when is risk to the baby highest?

A

If the mother acquires HIV during or just before pregnancy, they are at high risk of transmitting it to the baby

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14
Q

Is the placenta an effective barrier to transmission of HIV?

A

Yes BUT ONLY IF IT IS HEALTHY i.e. no malaria, no toxoplasmosis,.

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15
Q

At what time point does most perinatal HIV transmission occur?

A

Most transmission tends to occur towards the end of pregnancy (placenta not as good)

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16
Q

In twins, is the 1st or 2nd born more likely to get HIV from a HIV infected mother?

A

1st-born is twice as likely to get HIV

They spend more time in the birth canal + pass through the birth canal and “sweep it off vaginal secretions”, while second twin has more rapid delivery

17
Q

What event during birth/labour increases risk of HIV transmission? What decreases risk of transmission?

A
  • Prolonged rupture of membranes (PROM) is associated with increased risk of transmission
  • Elective C-section in affected mothers will halve the risk of transmission
18
Q

In a country where infant mortality from diarrhoea and other condition is high, is it better for HIV positive mothers to breastfeed or use formula?

A

Better to exclusively breastfeed in this context as infant mortality is already high from others and formula-fed babies are more likely to develop diarrhoea

19
Q

What does WHO recommend in terms of breastfeeding in HIV +ve mothers if infant mortality rate >40/1,000 live births?

A
  • Exclusive breastfeeding AND
  • ARVs for mother and baby

Facts:

4% risk of transmission /6 months of breast-feeding

The risk of HIV from drinking 1L of breastmilk from an HIV-infected person is the same as one episode of unprotected sex with an HIV-infected person

Avoidance of breast-feeding + ARVs = massively reduced the vertical transmission of HIV

20
Q

Other than targeting perinatal transmission, what does the WHO approach to preventing infant HIV consist of?

A
  1. Preventing HIV in parents-to-be
  2. Preventing unwanted pregnancies in HIV+ve women
  3. Care and support for HIV +ve families and children
  4. Preventing perinatal transmission
  5. Guidelines for ARV use for prevention/treatment
21
Q

List the types of ARVs and where they act.

A
  • Fusion inhibitors
  • CCR5 coreceptor antagonists
  • NNRTI
  • NRTI
  • Nucleoside/nucleotide analogues
  • Integrase inhibitors
  • Protease inhibitors
22
Q

How do HIV priorities differ between high and low income 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
    • Simple for healthcare workers to deliver treatment
23
Q

What are the challenges in treating adolescents with HIV?

A
  • Stigma/secrecy
  • Rejection
  • SE/toxicity of ARVs
  • Physical effects (growth, puberty, CNS)
  • Sex - sexually transmissible
24
Q

What are the challenges to HIV treatment in Africa?

A
  • Malnutrition
  • Poverty – lack of school fees, transport
  • Multiple co-infections (especially TB) and risk of immune reconstitution inflammatory syndromes (IRIS) – revamping the immune system can be BAD; must warn parents about this as otherwise they may stop the drugs
  • Cultural - some circumcision rituals may spread HIV so working together with tribes and treating them before these occur may help
  • Family disruption – multiple carers, children as caretakers
  • Stigma in school
  • Depression
25
Q

What are some methods for promoting adherence to HIV treatment in children?

A
  • Increasing use of peer-facilitators who talk about their personal experiences
  • Improved formulations and education - e.g. colourful tablets for children
  • Simplifying treatment - one tablet

a path 3 (89 decks)

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