More rapid clinical progression

30% have aggressive disease & rapid

progression to AIDS
How does it differ from adult HIV?
CNS involvement
Early PCP
Recurrent bacterial infections
Growth failure
• Incidence
• People living with HIV 40.3 Million – World
wide
• People living with HIV in India 5.1 million
• Children (< 15 yrs) estimated to be living with
HIV 2.5 Million
• Estimated AIDS Cases in India < 15 yrs 4854
Cases
Asymptomatic
Recurrent or more severe common infections
Failure to thrive/growth failure
PCP
Parotitis
LIP
LAB : Anemia, thrombocytopenia, lymphopenia,
elevated LFTs, hypergammaglobulinemia
STAGE 1
Asymptomatic
Generalized LAN
STAGE 2
Unexplained chr. Diarrhea
Severe persistent / rec. candidiasis
Weight loss / failure to thrive
Persistent fever
Rec.severe bacterial infections
STAGE 3
AIDS defining opportunistic infections
Severe failure to thrive
Progressive Encephalopathy
Malignancy
Recurrent septicemia or meningitis
 MAJOR
Weight loss/abnormaly slow growth
Chr.diarrhoea more than 1m
Pyrexia more than 1m
MINOR
Generalised LAN
Oropharyngeal candidiansis
Rec.common bacterial infections
Persistent cough more than 1m
Generalised dermatitis
Confirmed HIV infection in mother
2 major + 2minor in the absence of other known cause of
immunodeficieny
• Intrauterine 25-40%
• Intrapartum 60-75%
• Added risk of breast feeding 12-14%
• In the absence of ART transmission rates
16-40%
• AZT prophylaxis & use of HAART in
pregnant women transmission rates 5-6%
Diagnostic difficulties
I. 1st 18 months- transplacental
passage of IgG HIV Abs
II. Cord blood samples may be
contaminated with maternal blood
III. Difficulty in obtaining large
volume of blood required for some
diagnostic tests
Viral
HIV 1 DNA PCR(cells)
HIV 1 RNA PCR(plasma)
HIV 1 p24 Ag(plasma)
HIV 1 culture
Non viral
HIV 1 IgM or IgA Abs
In vitro Ab production
 ELISA
Confirmatory Western blot
HIV PCR
Qualitative(presence of pro-viral DNA)
Quantitative(HIV RNA copies in
sample)
Primary care of HIV infected children:

Maintain good nutrition

Growth monitoring regularly
Rx infections as early as possible
Emphasis on early diagnosis & Rx of
suspected Tb for all family members
Rx the child as normal
Immunisation
Give comfort when in pain & distress
RT inhibitors NNRTI’s
• Zidovudine(AZT) • Nevirapine
• Didanosine(ddi)
• Efaviren
• Epivir(3TC)
• Zerit(d4T) PI’s
• Abacavir • Nelfinavir
• Tenofovir • Ritonavir
• Sequinavir
 2RTI + 1PI; 2RTI + 1 NNRTI; 2PI ?
Advantages
Increased efficacy
Supress viral load
Increased CD4
Delays development of viral resistance
Problems
Tolerability
Cost
PK problems- metabolism,dose
Need different formulations
Infants
Failure to thrive
AIDS defining illnesses(cat.C)
Asymp. with CD4% <15 or CD4 <750
Symptomatic with CD4% <20

Children
Failure to thrive
AIDS defining illnesses(cat.C)
Asymp. with CD4% <15 or CD4 <200
• Early HIV infection (<3m)
• Early occurrence of 1st HIV related
condition
• Failure to thrive as presenting complaint
• High peak viral load by RNA,p24 Ag
• High maternal viral load at delivery
• Identify HIV infected pregnant women
• Prevent vertical transmission by perinatal
chemoprophylaxis with AZT
1. After 1st tr PO 100mg 5 times/day
2. Peripartum i.v 2mg/kg stat followed
by 1mg/kg/hr
3. Newborn 1st 6 weeks PO 8mg/kg/day
in div.dose 6th hourly
• Prevent horizontal transmission
• 4-6 wks – all infants born to HIV infected
women
• Infants of unknown HIV status – until
12m/until HIV infection is excluded
• HIV infected child 1-5yrs CD4 +<500
• HIV infected child 6-11yrs CD4 +<200
• Co-trimox 150mg/m2/day
• Annual tubercular skin test- 24m for all HIV +
• INH proph. 10-15mg/kg (max 300mg)×9m for
HIV+ children,children <3y who are in contact
with an adult diagnosed with TB
• INH CI
Previously received INH proph
Previously Rx for TB
Suspected of having active TB
Nelson textbook of paediatrics
Textbook of paediatrics- Suraj Gupte
Textbook of paediatric & adolesent AIDS-
Scott.W.Henggeler
Textbook of HIV/AIDS diagnosis &
management-Dr.Vinay Kulkarni
Preventive & social medicine- Park & park
Indian journal of paediatrics- March ’06
Paediatrics today - Jan ‘05