Paediatric HIV

Adults
Heterosexual sex intercourse is the most common mode of transmission.
IV drug users: mislead by statistics? ..due to compulsory screening.
How it involves children?
90% is due to Mother-child-transmission
- Rate of transmission from mother who is HIV positive
> 25% will get infected.
> 75% will not get infected.
Transfusions:
- Less common now. Blood product screenings.
Sexual Abuse:
- Uncommon!
- Why? > Most abuse case are fondling e.t.c.
- > Perpertrators are usually family members; unreported. Child/mother
scared.

HIV transmission
Although HIV can be found in blodd, urine, e.t.c. Only through genital secretion
s and blood.
I believe IV users are not infected through injection., but they get it sexually
. (Dr Zain, 2010)

Risk
Sexual Transmitted Disease
- Especially that cause ulcers
- E.g. Herpes, Syphillis
-
Breastfeeding:
- Mucosal membrane of babies not mature.
Vaginal Delivery
- Mucosal membrane are not mature.
- Blood, vaginal, cervical secretions swallowed.
Invasive procedures:
- Amniocentesis, CVSampling.
High viral load in mother, low CD4 count.

Diagnosis/ Lab investigations

Serology Test:
- If seen in child first time, more than 18mo. do the test!
- High sensitivity & specificity
HIV enzyme immunoassay (ELISA)
- Must be positive X2.
Confirm by Western Blot/ immunofluorecense assay.
Virology :
- For the definitive diagnosis.
- More specific, sensitive.
- Can be done in advance disease, when specific Ab is inadequate.
- Remain positive even after aggressive treatment.
PCR , (can detect HIV RNA, HIV DNA, p24 antigen)
- DNA; in the CD4 cells, during latent period (provirus)
- RNA; in the blood (virus),
If negative; repeat by 6 weeks. (definitive confirmation; infected or not)
Viral Culture
- Nobody do culture anymore

Hepatitis B (off topic)

90% of carriers (mother ) will transmit to child.
That is why we give immunoglobulin to prevent chronic carriers in children.

Risk of transmission through needle prick injury? > 10%

HIV 'behavior'/ progression
HIV latent period does not follow the natural progression such in adults (e.g. a
fter 6 month, low)
Newborn: immune not develop.
- Viral load very very high, and stays high.
- 1/3rd die within 1st year of life.
- Half die within 2nd year.
Common AIDS indicator disease in children
- Pneumocyctis jirovecei pneumonia (30%)
- HIV wasting syndrome
- Bacterial infections (multiple + recurrent)
- HIV encephalopathy
- Candida (esophageal, respi tract)
- Lymphoid interstitial pneumonitis
- Mycobacteria TB (extrapulmonary)
- CMV
- Cryptosporoidis
- Toxo encephalitis
- Lymphoma.

Prevention of transmission
Antenatal
- Antenatal care for mothers. HIV screening.
- Chemotherapy:
As early possible (mother)
Aim to suppress to undetectable level (sometimes may suppress viral load up to 5
0 copies/ml).
Cannot cure, only suppress viral replication.
Improves mother s health.
Prevent child infection.
Intrapartum
- Elective Caesar @ 38 weeks
Prevent microtransmission
- Chemoprophylaxis
Post-Partum
- Do not breastfeed
- Pneumocystis pneumonia prophylaxis
TREATMENT Chemotherapy
Always 3 drugs
Pregnant Mother
Nevirapine + efavirenz
Plus
Zidovudine + lamivudine
Child
Nevirapine (daily) until 4 weeks
Or
Zidavudine

Prophylaxis (always one drug)

Antepartum: Zidovudine
Intrapartum: nevirapine + Zidovudine + lamuvidine
Breastfeeding: Nevirapine, until 1 week after stop breastfeeding.
Who are the children we treat?
All children diagnosed at <2 years. Regardless CD4, sign symptoms
2- 5 years: guided by CD4.
- <25%
- <750 cells/mL
5+ years
- <350 cells/ml
All children with clinical stage 3-4 WHO
Regardless CD4 count.
Prognosis i.e. rate of transmission (mother-child)

Untreated mother 25%

Chemoprophylaxis drop to <10%
Chemo + Caesar drop to < 5%
Chemo until undectectable level drop to < 1%

Muhammad Sheth
December 17, 2010 at 7:05am · Like · Report
Muhammad Sheth Oh, time salin notes buat table form. Try copy paste kat sini tak
boleh plak. Xpe la. Pepandai la baca... Boleh faham kot rasanya...
December 17, 2010 at 7:08am · Like
Noor Mohd Amin horrornye aku present kes HIV td... huhu.... but i've learn somet
hings... dats for sure....
December 17, 2010 at 11:57am · Like
Muhammad Sheth tadi? Ko present kat siapa?
December 17, 2010 at 4:14pm · Like
Muhammad Sheth btw, kalu rajin share la point2 penting... Grup kitorang belum di
scuss long case HIV.
December 17, 2010 at 4:15pm · Like
Ahmad Faizul Abdrahmansazli ada ke dr zain ckp he believes IV users dont get inf
ected thru injection bit from SI?? aku rasa somewhat different, but cant recall.
..
December 17, 2010 at 4:24pm · Like
Noor Mohd Amin nnti aku share ape yg aku dpt td.... tp aku kene update2 sikit du
lu....
December 17, 2010 at 6:21pm · Like
Muhammad Sheth G: Ada.