INTRODUCTION:-

HIV IS SPREAD THROUGH BLOOD AND CERTAIN OTHER BODILY FLUIDS

ABOUT 90 PERCENT OF CHILDREN WITH HIV ARE INFECTED THROUGH THEIR
HIV-POSITIVE MOTHERS, EITHER BEFORE OR DURING BIRTH.

“HUMAN IMMUNODEFICIENCY VIRUS”

H = INFECTS ONLY HUMAN BEINGS.

I = IMMUNODEFICIENCY VIRUS WEAKENS THE IMMUNE

SYSTEM AND INCREASED THE RISK OF INFECTION.

V = VIRUS THAT ATTACKS THE BODY.

DEFINITION:-

ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) IS NOT A DISEASE IN

ITSELF. IT IS A CONDITION IN CAUSED BY HIV IN WHICH THE BODY’S IMMUNE
SYSTEM FAILS TO BATTLE FOREIGN MICROORGANISMS. THIS LEADS TO
VARIOUS OPPORTUNITIES INFECTIONS AND/OR CERTAIN CANCERS. IT IS THE
MOST ADVANCED STAGE OF HIV INFECTION.

OR

AIDS ACQUIRED IMMUNODEFICIENCY SYNDROME IS A DISEASE OF THE

HUMAN IMMUNE SYSTEM CAUSED BY INFECTION WITH HUMAN
IMMUNODEFICIENCY VIRUS. IN CHILDREN IT IS ACQUIRED PERINATALLY OR
BY VERTICAL-MATERNAL INFANT TRANSMISSION.

INCIDENCE:-

ACCORDING TO WHO-

 2-3 MILLION CHILDREN BELOW 15 YEARS ARE AFFECTED I.E. 7.7% OF

THE WORLD POPULATION.
 GLOBALLY 91% FROM VERTICAL TRANSMISSION.
 5% FROM NOSOCHROMBIAL TRANSMISSION.

4% FROM SEXUAL ABUSE

Anatomy and Physiology of the Immune System
Your immune system plays two vital roles in your body. First of all, it responds to foreign
organisms that gain access to your body by producing antibodies and stimulating specialized
cells that destroy the organisms or neutralize their toxic byproducts. In this manner, it
defends against foreign invaders, including: germs, viruses, bacteria, fungi, and parasites.
But it also stands guard over the cells of your body to ensure that they do not become
abnormal or degenerate.

The anatomy of the immune system

All blood cells, both red and white, begin as

stem cells in your bone marrow. These undifferentiated cells begin to assume individual
characteristics and become either red cells (the oxygen carriers) or white cells (the cells of the
immune system).

T he white cells (also called leukocytes) into four main types of cells:

 Lymphocytes
 T-cells
o Helper cells
o Natural killer (NK) cytotoxic T-cells
o Suppressor T-cells
o Memory T-cells
 B-cells
 Phagocytes
 Granulocytes
 Dendritic cells.

Lymphocytes

Lymphocytes are white blood cells that detect and destroy foreign invaders in various ways.
They serve as the key operatives of the immune system.

T-cells

T-cells work primarily through what is known as cell mediated immunity, which is another
way of saying that they do not instantly attack invaders on their own authority like antibodies
do, but rather require other cells to activate/mediate their response

T-cells primarily defend against viruses that have taken up residence in host cells and cells that have
turned malignant.

Helper cells

This is pretty much another name for T4 cells (CD4+). T4 cells are known as helper T-cells
because they help activate the antibody-mediated immune response by identifying foreign
invaders, then help activate B-cells, other T-cells, natural killer (NK) cells, and macrophages
to attack the invader.

Cytotoxic NK (natural killer) T-cells

These are mainly T8 cells that have been activated by T4 cells and "transformed" into killer
T-cells (AKA, Killer CD8+ T-cells).

Suppressor T-cells

These cells cause down-regulation of the immune response. Very little is known about them.

Memory T-cells

Once an invader is defeated, most of the active T4 and T8 cells dry up and disappear.
However, the T4 cells produce a clone of themselves called Memory Helper T-cells, which
can last a long, long time (anywhere from decades up until the day you die) to resist the next
invasion of that specific antigen

B-cells

The "B" in B-cells is now generally understood to refer to the "B" in bone marrow, where
they are generated. B-cells travel directly from the bone marrow into your bloodstream. An
antibody, by the way, is a soluble protein produced by B-cells that's capable of binding to
and destroying or neutralizing one particular foreign substance (antigen) in the body.

Antibodies

Antibodies are Y-shaped protein molecules produced by B-cells that function as your body's
primary immune defense. Compared to the other components of the immune system, they are
tiny.

Phagocytes

Phagocytes are the large white cells that eat and digest invading pathogens, primarily through
protease enzyme activity. There are several kinds of phagocytes:

 Macrophages
 Neutrophils
 Monocytes

Granulocytes

Granulocytes are named after the granular texture of their cytoplasm, which needless to say is
granular. They include neutrophils (which function like phagocytes, but have the granular
texture of granulocytes), eosinophils, basophils, and mast cells.

Dendritic Cells

Dendritic cells have long threadlike tentacles that are used to wrap up antigens and expended
lymphocytes and carry them to the lymph nodes for removal from the body.
CAUSES AND TRANSMISSION:-

 CAUSATIVE ORGAN IS HUMAN IMMUNE DEFICIENCY VIRUS.

 UNPROTECTED SEXUAL INTERCOURSE (VAGINAL, ANAL OR ORAL) IN
ADULTS.
 TRANSFUSION OF CONTAMINATED BLOOD.
 SHARING OF CONTAMINATED NEEDLES USED FOR INJECTABLE DRUGS.
 SHARING INFECTED NEEDLES FOR TATTOOS AND BODY PIERCING.
 FROM HIV INFECTED MOTHER TO HER CHILD DURING PREGNANCY
CHILD BIRTH OR BREAST FEEDING (LESS CHANCE).

RISK FACTOR

 ADVANCED MATERNAL DISEASE.

 HIGH MATERNAL VIRAL LOAD.
 PROLONGED RUPTURE OF MEMBRANES.
 VAGINAL BLEEDING.
 DURING BREAST FEEDING.

TYPES OF HIV VIRUS:-

THERE ARE TWO TYPES OF HIV VIRUS.

1. HIV – 1
2. HIV – 2

1. HIV-1 IF IS MORE COMMON WORLDWIDE IN EASILY TRANSMITTED IS

PATHOGENIC IN NATURE. DURATION OF HIV-1, INFECTION IS QUITE LONG
IS COMMONLY SEEN IN INDIA.

HIV-2 IS FOUND IN WEST AFRICA,MOZAMBIQUE, AND ANGOLA, IF LESS

EASILY TRANSMITTED, IS LESS PATHOGENIC. DURATION OF HIV-2 INFECTION
IS SHORTER. IS RELATIVELY RARE AND HAS NOT BEEN REPORTED FROM
INDIA.

SOURCE OF INFECTION:-

GREATER CONCENTRATION –

 BLOOD
 SEMEN
 CSP

LESSER CONCENTRATION –
  TEARS
 SALIVA
 URINE
 BREAST-MILK

CERVICAL AND VAGINAL SECRETIONS

PATHOPHYSIOLOGY:-

DUE TO ETIOLOGICAL FACTORS.

HIV VIRUS BINDS TO CDY RECEPTORS ON SURFACE OF T CELLS.

RNA ENTERS THE HUMAN CELL.

RNA TRANSCRIBES DNA BY ENZYME REVERSE TRANSCRIPTASE.

INTEGRATE INSERTS VIRAL DNA INTO HOST DNA.

VIRAL DNA IS TRANSCRIBED INTO MRNA.

M RNA IS TRANSLATED INTO PROTEIN – POLYPROTEIN.

POLYPROTEIN CONVERTS INTO GENOME BECOMES PERMANENT PART OF

CELL’S GENETIC STRUCTURE.

HOST CELL IS KILLED AS VIRUSES ARE RELEASED AND BUDDING PROCESS

STARTS.

DESTRUCTION OF T-HELPER CELLS AND IMMUNE RESPONSE DECLINES

CAUSING S/S.
SIGNS AND SYMPTOMS:-

 Infants. HIV status may be difficult to determine in the first year of like, so repeated tests
may be done. Symptoms may include:

 Failure to thrive. Delayed physical and developmental growth as evidenced by poor

weight gain and bone growth.
 Swollen abdomen. This is due to swelling of the liver and spleen.
 Swollen lymph nodes
 Intermittent diarrhea. Diarrhea that may come and go.
 Pneumonia
 Oral thrush. A fungal infection in the mouth that is characterized by white patches
on the cheeks and tongue. These lesions may be painful to the infant.

children. Symptoms seen in children older than 1 year of age can be divided into three different
categories, from mild to severe.

Clinical stage 1
Asymptomatic
Persistent generalized lymphadenopathy
Clinical stage 2
Unexplained persistent hepatosplenomegaly
Papular pruritic eruptions
Extensive wart virus infection
Extensive molluscum contagiosum
Recurrent oral ulcerations
Unexplained persistent parotid enlargement
Clinical stage 3
Unexplained moderate malnutrition not adequately responding to standard therapy
Unexplained persistent diarrhoea (14 days or more)
Unexplained persistent fever (above 37.5 °C, intermittent or constant, for longer than one
month)
Persistent oral Candidiasis (after first 6 weeks of life)
Severe recurrent bacterial pneumonia

Exams and Tests

Here are the tests a pregnant mother and her baby may have to diagnose HIV:

TESTS TO DIAGNOSE HIV IN PREGNANT WOMEN

All pregnant women should have a screening test for HIV along with other prenatal tests.
Women at high risk should be screened a second time during the third trimester.

Mothers who have not been tested can receive a rapid HIV test during labor.

Woman known to be HIV positive during pregnancy will have regular blood tests, including:
  CD4 counts
 Viral load test, to check how much HIV is in the blood
 A test to see if the virus will respond to the medicines used to treat HIV (called a
resistance test)

TESTS TO DIAGNOSE HIV IN BABIES AND INFANTS

Infants born to women infected with HIV should be tested for HIV infection. This test looks
for how much of the HIV virus is in the body. In infants born to HIV positive mothers, HIV
testing is done:

 14 to 21 days after birth

 At 1 to 2 months
 At 4 to 6 months

If the result of 2 tests is negative, the infant does NOT have an HIV infection. If the results of
any test are positive, the baby has HIV.

Babies who are at very high risk for HIV infection may be tested at birth.

Newborns at Low Risk of Perinatal HIV Transmission

Recommended Regimen Recommended Duration
 ZDV  ZDV administered for 4 weeks

Newborns at Higher Risk of Perinatal HIV Transmission

Recommended Regimen Recommended Duration
 2-drug ARV
prophylaxis with
ZDV and 3 doses
 ZDV administered for 6 weeks; 3 doses of NVP during the
of NVP (NICHD-
first week of life
HPTN
040/PACTG 1043
regimen), or

 Empiric HIV
therapy with  ZDV administered for 6 weeks; 3TC and NVP
ZDV/3TC/NVP, administered for 2–6 weeks, up to 6 weeks of agea
or

 Empiric HIV
 ZDV administered for 6 weeks; 3TC and RAL
therapy with
administered for 2–6 weeks, up to 6 weeks of agea
ZDV/3TC/RAL

Newborns with HIV Infection

Recommended
Recommended Regimen
Duration
  Lifelong
 HIV therapy with ZDV/3TC/NVP, or
therapy

 Lifelong
 HIV therapy with ZDV/3TC/RAL
therapy

Indication
Low Risk Higher Risk Prophylaxis: Higher Risk Prophylaxis:
Drug
Prophylaxis 2-Drug Empiric and HIV Therapy
≥35 Weeks Gestation at Birth
Birth–4 Weeks:

≥35 Weeks Gestation at Birth:  ZDV 4 mg/kg/dose orally twice

daily
 ZDV 4 mg/kg/dose orally twice
daily Age >4 Weeks:

Simplified Weight-Band Dosing for  ZDV 12 mg/kg/dose orally twice

Newborns ≥35 Weeks Gestation at daily
Birth:
ZDV Simplified Weight-Band Dosing for
Volume (mL)
Weight Newborns Aged ≥35 Weeks Gestation
ZDV 10 mg/mL Oral
Note: For Band (kg) from Birth to 4 Weeks:
Syrup Twice Daily
newborns
2 to <3 kg 1 mL Volume (mL)
unable to Weight
ZDV 10 mg/mL Oral
tolerate oral 3 to <4 kg 1.5 mL Band (kg)
Syrup Twice Daily
agents, the 4 to <5 kg 2 mL
IV dose is 2 to <3 kg 1 mL
75% of the 3 to <4 kg 1.5 mL
oral dose 4 to <5 kg 2 mL
while
maintaining ≥30 to <35 Weeks Gestation at Birth
the same Birth to Age 2 Weeks:
dosing ≥30 to <35 Weeks Gestation at Birth
Birth to Age 2 Weeks:  ZDV 2 mg/kg/dose orally twice
interval.
daily
 ZDV 2 mg/kg/dose orally twice
daily Age 2 Weeks to 6–8 Weeks:

Age 2 Weeks to 4–6 Weeks:  ZDV 3 mg/kg/dose orally twice

daily
 ZDV 3 mg/kg/dose orally twice
daily Age >6–8 Weeks:

 ZDV 12 mg/kg/dose orally daily

MANAGEMENT:-

 POST – EXPOSURE PROPHYLAXIA (PEP) ANTIRETROVIRAL DRUGS ARE

USED WITHIN 72 HOURS OF EXPOSURE TO HIV IN ORDER TO PREVENT
INFECTION.
 COUNSELING, FIRST AID CARE AND HIV TESTING ARE ALSO DONE. A 28-
DAYS COURSE OF ANTIRETROVIRAL DRUGS WITH FOLLOW-UP CARE IS
ADVISED DEPENDING ON THE LEVEL OF RISK.
 PEOPLE EXPOSED TO ANY OF THE RISK FACTORS ARE STRONGLY
ADVISED TO TEST FOR HIV AND OTHER STIS.
 MOTHER-TO-CHILD TRANSMISSION (MTCT) DURING PREGNANCY,
DELIVERY OR BREASTFEEDING CAN BE FULLY PREVENTED IF BOTH
THE MOTHER AND THE CHILD ARE PROVIDED WITH ANTIRETROVIRAL
DRUGS.
 MALE CIRCUMCISION REDUCES THE RISK OF HETEROSEXUALLY
ACQUIRED HIV INFECTION IN MEN BY APPROXIMATELY 60%.
 USE STERILE NEEDLES AND SYRINGES FOR EACH INJECTION.
 ANTIRETROVIRAL THERAPY DECREASES THE HIV CONCENTRATION
(VIRAL LOAD) IN THE BLOOD AND IN GENITAL SECRETIONS.
 THERE IS NO CURATIVE TREATMENT OF HIV AIDS NO VACCINE ARE
AVAILABLE FOR PREVENTION. SO CHILDREN SHOULD BE PROTECTED
FROM CONTACTING THE HIV INFECTION.
 IMMUNIZATION CAN BE GIVEN TO HIV INFECTED INFANT AND
CHILDREN I.E. ARE HEPATITIS B, POLIO VACCINE, MMR, BCG ETC.
 PLENTY OF FLUID SHOULD BE PROVIDED.
 NUTRITIONAL FOOD SHOULD BE GIVEN.
 MEDICATION LIKE ANTIDIARRHOEAL, ANTIPYRETICS, ANALGESICS,
ANTITURSIVE DRUG SHOULD BE GIVEN.
 ANTIRETROVIRAL DRUGS IS GIVEN WHEN THE CHILD HAVE SIGNS OF
IMMUNE DEPRESSION OR HIV ASSOCIATED SYMPTOMS, ARE
DIDANOSINE, ZALCILABINE, STAUDINE ETC, THESE ARE USED FOR
PROLONGATION OF LIFE.
 OTHER DRUGS LIKE PROLEASE INHIBITORS, NON NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS IS ALSO GIVEN WITH ANTIRETROVIRAL
COMBINATION THERAPY

PREVENTION:-

ANTIRETROVIRAL TREATMENT WITH COMBINATION THERAPY OR POST

EXPOSURE PROPHYLAXIS TO PREVENT HIV IN CHILDREN.
  VERTICAL TRANSMISSION CAN BE PREVENTED BY ZIDOSUDINE
PROPHYLAXIS TO THE INFECTED PREGNANT WOMEN AND TO INFANT
TILL 6 WEEKS OF LIFE.
 HEALTH EDUCATION SHOULD BE GIVEN TO PEOPLE TO AVOIDING
BLOOD BRONE HIV TRANSMISSION.
 PROVIDE SPECIFIC PROPHYLAXIS FOR HIV MANIFESTATIONS.
 PARENT TO CHILD TRANSMISSION CAN BE PREVENTED BY AVOIDING
INDISCRIMATE SEXUAL PRACTICES OF ADULTS.
 HETICULOUS SCREENING OF BLOOD AND BLOOD PRODUCTS SHOULD
BE DONE BEFORE BLOOD TRANSFUSION.
 STERILIZED SYRINGE AND NEEDLE SHOULD BE USED FOR
IMMUNIZATION.
 ASEPTIC TECHNIQUES SHOULD BE USED DURING DELIVERY.
 PROMOTING COMMUNITY AWARENESS OF SPREAD OF HIV INFECTION
FOR UNSAFE PRACTICES.

NURSING DIAGNOSIS:-

 RISK FOR INFECTIONS RELATED TO IMMUNODEFIENCY RATE.

 ALTERED NUTRITION RELATED TO ANOREXIA, PAIN IN ABDOMEN. .
 DIARRHEA AND DEHYDRATION RELATED TO ENTERIC PATHOGENS AND
INFECTION.
 ALTERED PAIN RELATED TO ADVANCED HIV DISEASES.
 FEAR AND ANXIETY RELATED TO DIAGNOSTIC AND TREATMENT
PROCEDURES.
 KNOWLEDGE DEFICIT REGARDING TRANSMISSION OF HIV INFECTION.

CONCLUSION

PEDIATRIC HIV INFECTION IS CONTRIBUTING INCREASINGLY TO CHILDHOOD

MORBIDITY AND MORTALITY. MOST CASES RESULT FROM MTCT. EFFORT
SHOULD BE MADE PREVENT MTCT COMPLETE CARE PROVIDED FOR INFECTED
CHILDREN AND THEIR FAMILIES
BIBLIOGRAPHY:-

1. DUANE’S FOUNDATION OF OPHTHALMOLOGY. 2007;

2. UNAIDS, AIDS EPIDEMIC UPDATE: SPECIAL REPORT ON HIV/AIDS:
DECEMBER 2006. AVAILABLE FROM:
HTTP://DATA. UNAIDS.ORG/PUB/EPIREPORT/2006/2006 EPIUPDATE
EN.PDF. (LAST ACCESSED ON 2007 OCT 31).
3. ARTIDE ON OCULAR MANIFESTATIONS OF HIV/AIDS PATIENTS IN
GONDAR UNIVERSITY HOSPITAL, NORTH WEST ETHIOPIA.
4. UNAIDS/WHO. ADIS EPIDEMIC UPDATE; 2004.
5. DISEASE PREVENTION AND CONTROL DEPARTMENT, MOH. AIDS IN
ETHIOPIA: FIFTH REPORT. JUNE 2004.