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HIV in Children

Outline
Epidemiology
and Etiology

Pathophysiology
Clinical
Manifestation
Diagnosis

Treatment

Prognosis
Epidemiology
Indonesia -> first found in 1985, reported
officially in 1987 in Bali. Dramatically
growth happened in 1999 -> the usage
of needle number was also growing.

46,3% is caused by needle usage and


7% is caused by his/her sick couple who
used needle.
Etiology

Human Immunodeficiency Virus (HIV), RNA


virus, retroviridae family and lentivirus
subfamily.

Two kind of HIV : HIV-1 and HIV 2

HIV-1 is common etiology of HIV/AIDS infection world


wide, Pan troglodytes, where the virus does evolution in
hundreds years.
HIV-2, genetically look like simian immunodeficiency
virus (SIV) which is found in Cercocebus atys.
HIV Transmission in mother
with HIV
Ilustration of HIV Structure
HIV Replication Cycle
Pathophysiology

Lower immune system -> helper T cell


number goes down progressively (in
quality and qualitative)
Helper T cell can be found in CD4
surface, the main receptor of HIV
If CD4 lessen, HIV patient -> high risk of
opportunistic infection
HIV infection There is no clinical manifestation shown,
characteristic but HIV always replicate (10 particles
per day) -> mutation and selection ->
resistent HIV (mostly in lymph node)
HIV particles goes up, CD4 number goes
down.
First manifestation of HIV infection is
micro damage on lymp node follicle
architecture and in lymphoid tissue
HIV Transmissions

The transmission
of HIV is done
by sexual HIV doesn't
contact transmitted by
homosexual or skin contact or
heterosexual, bug bites
from blood and
blood product
the mother to baby
Clinical Manifestation

Uncharacterized symptoms AIDS

Fever Weight loss


Sorethroat Prolong fever
lymph node and gland Malaise
swelling Lymph node and gland
rash swelling
Diarrhea chronic diarrhea
Cough Milliaria
acute infection in 3-6 weeks Headache
after infection Dry cough
After that, HIV will become Vision disturbance
AIDS in 8-10 years Infection, e.g. tuberculosis,
fungi, herpes, cancer
Clinical Manifestation in
Children
Bad nutrition
status
(kwashiorkor/mar
asmus)
Children usually
developing Growth
severe nutrition disturbance
status after using (stunted)
ARV

High risk of Always


opportunistic underweight
infections (wasting)

Mental
Retardation
Physical Examination

AIDS' patient usually come


with complain on his/her
secondary infection

The results of physical


examination vary, depend
on the secondary infection

The secondary infection


usually related with
immune system
Diagnosis
Certain diagnosis :
laboratory 3 WHO Strategies
examinations
Serologic examination (body
antibodies) 1st strategy -> one time
ELISA (enzyme-linked immunosorbent examination
assay),
agglutination or dot-blot
immunobinding assay
2nd strategy -> twice
examinations, if the first shown
Detection of HIV in the body reactive result
Isolation and virus culture
Antigen detection 3rd strategy -> three
Gen material detection in the blood examinations, and reported as
HIV, if all of the examination
whon reactive results.
Treatment
Antiretroviral (ARV) -> HIV replication reduction
nucleoside reverse transcriptase inhibitor, nucleotide reverse transcriptase
inhibitor, non-nucleoside reverse transcriptase inhibitor, and inhibitor
protease
Use for all AIDS patient
AIDS or severe symptom, without CD4+ number considerations.
asymptomatic patient with CD4+ <200 cells/mm3.
asymptomatic patient with CD4+ 200-350 cells/mm3,
asymptomatic patient CD4+ > 350 cells/mm3 and viral load > 100.000
copy/ml ARV can be postponed.
Not recommended for patient with CD4+ >350 cells/mm3 and viral load
<100.000 copy/ml
Pregnant woman

Treatment for secondary infection (infection and cancer)

Supportive = balance diet and psychosocial support


ARV Indication in newborn
and children
ARV in Indonesia
Patent Name Generic Name Stage Preparations Dosages (per day)
Tablet, composition :
Duviral zidovudin 300 mg, 2 x 1 tablet
lamivudin 150 mg
Stavir Stavudin (d4T) NsRTI Capsule: 30 mg, 40 mg >60 kg: 2 x 40 mg
Zerit <60 kg: 2 x 30 mg

Tablet 150 mg Oral fluid 10 2 x 150 mg<50 kg: 2 mg/kg,


Hiviral Lamivudin (3TC) NsRTI
mg/ml 2x/hari
3TC

1 x 200 mg for 14 hari, continue


Viramune Nevirapin (NVP) NNRTI Tablet 200 mg
with 2 x 200 mg
Neviral

2 x 300 mg or 2 x 250 mg
Retrovir Zidovudin (ZDV, AZT) NsRTI Capsule100 mg
(alternative dose)
Adovi
Avirzid
>60 kg: 2 x 200 mg or 1 x 400
Videx Didanosin (ddI) NsRTI Chewy Tablet: 100 mg mg<60 kg: 2 x 125 mg or 1 x 250
mg

Stocrin Efavirenz (EFV, EFZ) NNRTI Capsule 200 mg 1 x 600 mg, at night

Nelvex Nelfinavir (NFV) PI Tablet 250 mg 2 x 1250 mg


Viracept
Treatment of HIV in Tuberculosis patient

There is Didanosin + Rifampisin


Tuberculosis in interaction OAT -> have can lower
Zidovudin
Indonesia is in between ARV to be given nelfinavir and
+OAT -> toxic
third leading and anti with 1 hour nevirapin's
effect more
number tuberculosis interval dosages in
dangerous
worldwide (OAT) drugs -> between blood
hepatotoxicity drugs significantly
ARV Therapy
Development

enfuvirtide
Fusion inhibitor
There are two Expensive and not
new class : practical
enfuvirtide
and maraviroc
maraviroc Inhibition of HIV to
go to T Cell
Prognosis

Prognosis of
Mortality AIDS infection is
number can be related with
reduced thanks infection time,
to ARV drug treatment
combination access and
and life hope when the
has gone up. treatment
begin.
Growth Chart
Interpretation
Weight for Height Percentile Interpretation
Percentile < 5: Underweight
Percentile >= 5 and < 85: Healthy weight
Percentile >= 85 and < 95: At risk of overweight
Percentile >= 95: Overweigh
Growth Chart
Interpretation
Height for Age Percentile Interpretation
Percentile < 5: Short stature
Percentile >= 5 and < 95: Normal stature
Percentile >= 95: Tall stature
Nutrional Status and
Anthropometric Measure
Growth Chart
According to CDC,
Weight-for-age is under 5th
percentiles = Low Weight
(Ideal = 20 kg)
Weight/Age
= 10/20 *100% = 50%
(Underweight)
Stature for age is in 5th
percentiles = Normal
= 105/115 * 100% = 91,3%
(Normal)
Growth Chart
BMI/Age
BMI
= 6 kg /105 cm/105 cm x
10.000
= 5,44
BMI to Age is under 5th
percentiles
Interpretation =
Underweight
Growth Chart
Weight for
Stature
Weight for stature = below
5th percentile =
Underweight
6kg/16,9 kg * 100% = 35,5%
(severe undernutrition)
From three indicators above, can be concluded
that the girl, 6 years, 10 kgs, and 105 cms, has an
undernutrition condition.
Thank You