HIV in Pediatric

HIV : Human immunodeficiency Virus

AIDS : Acquired Immune Deficiency Syndrome → is a collection of symptoms and infections in humans resulting from the specific damage to the immune system / deficiency cellular immune caused by HIV infection

Characterized :

reduction of the Helper T-lymphocytes

opportunistic infections and

development of malignant neoplasms

First case : 1981, USA — adult homoseksual

In the world, > 8,000 death every day — 1 person every 10′

Immunologic manifestation :

Helper T menurun

IgG and IgA meningkat

Natural killer cell menurun

Macrophag menurun : skin test — Anergi

Tuberculin

Mumps

Candida albicans

Epidemiology

1983 oleske, rubinstein and amman : AIDS in children in USA

Higher HIV infection in the world : Africa especially Africa sub-sahara (40% population)

1988 : southeast Asia – Thailand first report AIDS in children

World epidemiology HIV / AIDS until Desember 2005

Total : 40.300.000

<15 year 2.300.000

New case : 4.900.000

<15 year 700.000

Dead caused by AIDS : 3.100.000

<15 year : 570.000

Near 1.800 baby born HIV (+) / day

Developing country : HIV transmision risk to child 25 – 40 %.

Comprehensive preventive transmission : < 10%

Infection :

Unsafe sex

IDU ( Intra vena Drug User )

HIV (+) baby

HIV (+) mother : 25 – 40% HIV (+) baby

Development country : < 5%

Transmission from mother : depend on mother health

More suspected : mother with other diseases ( STD, Hepatitis B and C )

National Epidemiology HIV/AIDS (2006)

> 6.500.000 women potential infected

> 24.000 productive women : HIV (+)

> 9.000 pregnant women HIV (+) / year

> 30% baby HIV (+) → PMTCT (PREVENTION MOTHER TO CHILD TRANSMISSION)

Jakarta, Bandung, Bali, and Papua : ”red lamp” HIV/AIDS

Mother-to-child transmission = MTCT

HIV in children :

90% MTCT

10% transfusion

RSCM ; 2003 -2005 — 85, 13 meninggal

NORTH SUMATERA : 2006 : 102 SEXUAL TRANSMISSION, 96 DRUG, 15 TRANSFUSION & OTHER CAUSE

RSHAM ; HIV IN CHILDREN : 2004 – 2007 — 15

Etiology

Montagnier, Perancis, 1983

Gallo, Amerika, 1984

Retrovirus subgroup lentivirus

Transmission

Sexual

Transfusion

IDU

Vertical transmission

Breastfeeding

Others

Incubation periode

Adult : 3 month-antibody anti HIV (window periode)

Clinical manifestation : immediately – many years later

< 1 year, viremia can detected early life – 1 year

Opurtinistic infection : clinical manifestation in 2 mo life

Clinical manifestation

Asymptomatic → AIDS

Microorganisme infection from environment

Failure ti thrive, weight loss, anemia, reccurent fever, limphadenopaty, and hepatosplenomegaly

Oportunistic infection

AIDS defining illness

Failure to thrive

Prolonged diare

Prolonged fever

Oral candidiasis

Pulmonary tuberculosis

Pneumonia

Laboratory examination

Many place in Indonesia

–Clinical manifestation and serologic (+)

–Parents suspected HIV (+)

Some place

–Clinical manifestation and serologic (+) PLUS CD4

Jakarta

–Clinical manifestation

–Serologic, CD4 and PCR RNA

Screening

Abandoned babies/street children

Babies of mother with high risk behaviour

(drug addicts/prostitutes/multiple sex partner/single-teenage or underage)

Babies of HIV positive mother

Sexually abused children & children with sexually transmitted disease

Children receiving regular blood transfusion/ blood products e.g Thalasemia

Follow up schedule for infants of HIV infected mother

Repeat as soon as possible

Management

Opportunistic infection : treatment

Counseling : parents and / or family about nutrition, hygiene, follow up

ARV indication ( time ? )

ARV : controlling

Psychosocial support

Frist line regimen :

AZT + 3TC + NVP / EFV

d4T + 3TC + NVP/EFV

ABC + 3TC + NVP/ EFV

AZT à Zidovudine

3TC à Lamivudine

NVP à Nevirapine

EFV à Efavirenz

d4T à Stavudine

ABC à Abacavir

ddl à Didanosine

PI à Protease inhibitor

LPV/r à Loponavir/ritonavir

NFV à Nelfinavir

SQV/r à Saquinavir/ritonavir

PMTCT Intervention pattern

PMTCT (Prevention of Mother HIV to Child Transmission)

–Prevent mother / candidate from HIV inf.

–If HIV (+), prevent unplanning pregnancy

–Prevent transmission ( ARV, SC, ARV baby, no breastfeeding )

–Care and support

Prevention

Delivery & Infant Nursing

All equipment used during delivery should be cleaned & sterilised

Cord blood sample collected using a syringe & needle

Nursery

Gloves must be worn

Thermometer must be of individual use & suction catheter should be of single use

Disposable diapers

Washed off the contact with body secretion

All sharp according to the ministry of health guidelines

Circumcision lower the incidence of HIV 60% according to WHO. Millions of people in the world could be saved from HIV by this method.

Barber & circumcision equipments must be cleaned before used

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