Paediatric HIV Flashcards
20 years ago, there was no way to prevent or treat child ___ infection
HIV
____ OF HIV+ are on ARVs (2019)
47%
New infections ______ since 2010 (10k new infections in 2019)
halved
______ children living with HIV (2019)
340k
_______________________________ is a fast-track framework created by global organisations
Start Free, Stay Free, AIDS Free
Start free - Prevent Mother to Child Transmission (PMTC)
High viral load is =
High viral load is = increased risk of transmission
Start free - Prevent Mother to Child Transmission (PMTC)
Strategy 1 (most important goal of PMTC):
Strategy 1 (most important goal of PMTC): early, rapid and sustained maternal viral load suppression
Start free - Prevent Mother to Child Transmission (PMTC)
Strategy 2:
Infant PEP (NVP/AZT)
What is the goal regarding pregnant women living with HIV according to the provided information?
The goal is to reach 95% of pregnant women living with HIV and sustain them on lifelong antiretroviral therapy.
What is one of the objectives related to preventing HIV transmission in women of childbearing potential?
One objective is to prevent primary HIV infection among women of childbearing potential.
How is preventing unwanted pregnancies among HIV-positive women addressed?
Preventing unwanted pregnancies among HIV-positive women is addressed as one of the objectives.
What is the importance of prevention of mother-to-child transmission (PMTCT) programs?
Without PMTCT programs, 1 in 3 babies born to HIV-positive mothers will become HIV-positive. With single-dose Nevirapine during delivery, this risk decreases to 1 in 10. With antiretroviral therapy (ART) for mothers and post-exposure prophylaxis (PEP) for babies, the risk further decreases to 1 in 100.
How should HIV-positive mothers be supported according to the provided information?
HIV-positive mothers should be provided with appropriate treatment, care, and support, and efforts should be made to engage fathers in this process.
Antenatal:
Postpartum:
Mothers should adhere to _____ and have their viral loads monitored throughout pregnancy and breastfeeding
Breastfeeding is encouraged in HIV+ mothers because benefits outweigh the _______
BF+ aims to prevent ____ in breastfeeding HIV- and HIV+ women
ART
harms
MTC
Infant Prophylaxis at Birth:
Principle 1 -
Infant Prophylaxis at Birth:
Principle 2 -
Infant Prophylaxis at Birth:
Principle 3 -
Definition 1
Low Risk =
Definition 2
High Risk =
For breastfeeding infants on high-risk prophylaxis: If maternal viral load is not suppressed by 12 weeks, continue NVP prophylaxis until maternal VL is ________, or until 1 week after breastfeeding stops
<1000c/ml
What age group of adolescents needs urgent intervention for the prevention of new HIV infections, particularly among girls?
Adolescents aged 15-19 years old, especially girls, require urgent intervention due to high transmission rates and disempowerment in negotiating condom use.
What are some recommended interventions for preventing new HIV infections in adolescents?
Recommended interventions include talking to children about sex and consent, voluntary male circumcision, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), access to secondary and higher education, and integration of sexual and reproductive services with HIV services for young people.
Why are 15-19-year-old girls particularly vulnerable to HIV infection?
15-19-year-old girls are particularly vulnerable due to high transmission rates and challenges in negotiating condom use, often stemming from social and gender-related factors that disempower them.
What is PrEP and how does it help in preventing HIV infections?
PrEP stands for pre-exposure prophylaxis, which involves taking antiretroviral medication regularly to prevent HIV infection in individuals who are at high risk. It provides an additional layer of protection against HIV transmission.
How can the integration of sexual and reproductive health services with HIV services benefit young people?
Integrating sexual and reproductive health services with HIV services ensures that young people have comprehensive access to prevention, testing, and treatment services in one location, which can improve uptake and effectiveness of interventions.
Define AIDs free:
Ensure ART access to 95% of HIV infected children
Why do foetuses and newborns typically experience more rapid and extensive HIV replication compared to older hosts?
Foetuses and newborns have immature immune systems, leading to more rapid and extensive HIV replication. Consequently, there is a more rapid disease progression in children, with approximately 50% of HIV-positive children expected to die within two years without antiretroviral therapy (ART).
How do viral loads in HIV-positive children change as they age?
Viral loads are higher in the first year of life and then decline to adult values by 5-6 years of age.
What is the significance of CD4 counts in infants compared to older children and adults?
Absolute CD4 counts are much higher in infancy, with counts exceeding 3000 cells/mm³.
How does the CD4 percentage change in children with HIV, and what does it correlate with?
The CD4 percentage remains constant in children and correlates with disease progression, serving as an important marker for monitoring HIV progression and treatment response.
What are some strategies used to ensure access to ARTs?
Diagnose ASAP (highest mortality between 6 weeks and 4 months)
Early diagnosis and treatment decreases risk of HIV encephalopathy and opportunistic infections
Treatment must be effective, well tolerated, simple and universal
Adults have 1 big tablet to take once a day but children have multiple syrups (some are bad tasting) and
vitamins that need to take bidaily – this is unfair. Additional TB medication is even worse
Cher study – when to start ART?
- Diagnosis and tx before 3 months of age showed much better outcomes (decreases mortality and developmental delay)
Non-progressors: (3)
Slow progressors: (3)
Rapid progressors: (3)
National ART regimens:
< 20kg
Abacavir (ABC) + Lamivudine (3TC) + Lopinavir (LPV/r) ifn<20kg
National ART regimens:
> 20kg
Dolutegravir (DTG) if > 20kg
Psychosocial criteria to start child on ART:
Mandatory:
At least one identifiable caregiver who is able to supervise child or administer medication
Psychosocial criteria to start child on ART:
Recommended:
Disclosure to another adult living in the same house is encouraged so that there is someone else who can assist with the child’s ART
Criteria for fast-tracking for ART:
Is disclosure of HIV status a one-time event?
No, disclosure of HIV status is an ongoing process, not a one-time event.
At what age should HIV status be properly explained to children?
HIV status should be properly explained to children at 8-9 years old, and the topic should be revisited at every visit thereafter.
At what age do individuals have a legal right to know their HIV status?
Individuals have a legal right to know their HIV status at 12 years of age.
Who ideally should disclose HIV status to children?
Ideally, HIV status should be disclosed by caregivers, such as parents or guardians.
How does disclosure of HIV status contribute to improved health outcomes?
Disclosure of HIV status improves adherence to treatment and mental health, as it is the number one predictor of poor adherence.
What are the pharmaceutical Challenges for Paediatric ART? (5)
How many children globally are in need of antiretroviral treatment (ART), and what percentage are on a suboptimal regimen?
Globally, 2.1 million children are in need of ART, with 40% of them on a suboptimal regimen.
What is a common concern regarding the available formulations for paediatric ART?
A common concern is that there is “too much of what we don’t need,” indicating that the current formulations may not adequately meet the needs of children living with HIV.
Care of the HIV-exposed but Uninfected (HEU) infant
3.8 million HEUs – higher risk for growth deficits, neurodevelopmental delays, infections and death Identify high-risk HEU infants and ensure more regular monitoring for: (5)
