Please enable JavaScript.
Coggle requires JavaScript to display documents.
HIV in children (Clinical presentation (Lymphademopathy, Enlarged…
HIV in children
Clinical
presentation
Lymphademopathy
Enlarged parotids
Asymptomatic
Recurrent infections
e.g. pneumonias
Candidiasis
Chronic diarrhoea
Failure to thrive
Prevention
Postnatal ART
Babies born to HIV+ve mothers
Maternal HAART
Reduces viral load
Careful labour and delivery
Avoid PPROM and instrumentation
CS if detectable viral load
But fine for NVD if low load
Breastfeeding
Avoid if detectable load,
fine if undetectable load
Pathophysiology
Transmission
Intrauterine, intrapartum or postpartum (breastfeeding)
Blood products, infected needles, sexual abuse (rare)
Mechanism
Often asymptomatic initially if vertical, some can progress rapidly to AIDS; may occur in first few months or years of life
If non-vertical, a typical seroconversion picture may be seen
Agent
Retrovirus HIV-1
Diagnosis
History
POH
Bloods (BBV screen?), scans, growth, delivery (method),
gestation, weight, complications
PMH
Growth and development
Illnesses and accidents (infections, cancers)
Known medical conditions
DH
Meds, allergies
PC/HPC
Recurrent infections, diarrhoea, failure to thrive,
weight loss, myalgia, fatigue
FH
Known HIV+ parents
SH
Living arrangements, siblings at risk,
social services involvement
Examination
General
Lymphadenopathy, hepatosplenomegaly,
clubbing
Investigations
Bloods
FBC (low WCC, low Plt, CD4 count), CRP, U+E, LFTs
Virology (HIV PCR for viral load)
Serology (HIV IgM IgG; may be false +ve in first few months of life due to Igs from mother)
Imaging
CXR: if suspect e.g. TB
Bedside
Obs (fever)
Measurements (weight loss)
Complications
Infections
As per adults
Shingles (extensive, multi dermal)
Molluscum contagiosum (extensive)
Lymphocytic interstitial pneumonia (LIP)
Pneumocystocis, toxoplasmosis,
cryptococcosis, histoplasmosis, TB, JCP
Cancers
RARE in children
Prognosis
With tx, becomes a chronic condition
Without tx, 50% with early
opportunistic infections die <3y
Epidemiology
Rare in UK (perinatal transmission <1%)
Common in sub-Saharan Africa
Management
Conservative
Information, advice, support
MDT family management (paeds, ID, specialist nurse, pharmacist, play therapist, dietician, psychologist)
Immunisations (influenza, HBV, HCV, VZV,
not
BCG as live)
Safety (safe sex, fertility, pregnancy)
Medical
HAART
Indication: low viral load, AIDS, pt preference
SEs: hyperglycaemia, liver toxicity, hyperlipidemia
Screening
Antenatal screening programme
BBV bloods
Newborn
HIV PCR test for all children born to
HIV+ve mothers (2 -ve PCRs in first 3m of life)
Test at 0, 3 and 6m (PCR, P24 Ag, IgA)
Definition
Infection of a child
with HIV