mwebazavictor1997@gmail.com

1. M W E B A Z A
VICTOR
BMS/9114/172/DU
Africa Uganda
PAEDIATRIC HUMAN
IMMUNODEFICIENCY
VIRUS(HIV/AIDS)
MUBENDE RRHosp-KIU
-WC
Pediatric department
2021

2. OUT LINE:-
• Back ground
• Introduction
• Definitions
• Pathophysiology
• Epidemiology
• Children with HIV/AIDS
• Signs that may indicate possible HIV
infection in children
• Signs common in HIV infected
children's but also occur in I'll
children.
• Condition specific to HIV infected
children
• Testing and diagnosis of HIV in
children
• Clinical staging
• Antretro viral therapy
• Antretro viral recommended for use
in children by WHO
• WHO first line treatment regimen for
children
• when to start ART
• Common side effects and monitoring
• When to change treatment
• Supportive care for HIV positive
children
• Co-trimaxozole prophylaxis
• Nutrition
• Management of HIV related
conditions
• Preventing paediatric HIV infection
• Infant feeding in the context of HIV
infection
• Adolescent issues
• Counseling and psychological
support
• Follow up

3. • Introduction
• HIV/AIDS is a major cause of infant and childhood mortality and
morbidity in Africa. In children under five years of age, HIV/AIDS
now accounts for 7.7% of mortality worldwide. AIDS already
accounts for a rise of more than 19% in infant mortality and a 36%
rise in underfive mortality. Together with factors such as declining
immunisation, HIV/AIDS is threatening recent gains in infant and
child survival and health.
• In Africa, high rates of maternal HIV infection, high birth rates, lack
of access to currently available and feasible interventions, and the
widespread practice of prolonged breast-feeding translate into a
high burden of paediatric HIV disease. The transmission risk for a
child born to an HIV-infected mother in an African setting without
interventions for prevention of mother-to-child transmission
(PMTCT) is about 30–40%. The other 60–70% of children, although
not HIV-infected, still have a 2- to 5-fold risk of mortality as a direct
consequence of the mother’s HIV disease, when compared to
children born to uninfected mothers.

4. DEFINITION
HIV is a viral infection that affect the body's immune
system specifically the white blood cells called the CD4
cells . HIV destroy the CD4 cells thus weakening the
child's immunity against infections such as Tuberculosis
and some cancers.
(According to WHO )

5. Acquired immunodeficiency syndrome (AIDS)
AIDS is defined in terms of either a CD4+ T cell count
or the occurrence of specific diseases in association
with an HIV infection.
AIDS is the term that applies to the most advanced
stages of HIV infection. By definition is the
occurrence of any of the more than 20 life-
threatening cancers or opportunistic infection. so
named because they take advantage of a weakened
immune system( W.H.O 30/11/2020)

7. • December 1 is World AIDS Day, a day to unite in
the fight to end the HIV epidemic, support people
living with HIV, and honor those who have lost
their life.

10. • Pathophysiology

11. • Effect on Immune System
The basic effect of HIV on the immune system is CD4+ cell
depletion and dysfunction. The functional defects can
occur before cell numbers decline. Other immunological
defects caused by HIV include lymphoid tissue destruction,
CD8+ cell dysfunction, B-cell abnormalities, thymus
dysfunction, and autoimmune abnormalities.
Non-HIV-infected infants and young children normally have
higher CD4+ counts than adults. The normal CD4+ count
varies with age (and probably with region), reaching adult
levels around 5 or 6 years of age.

12. Cont.
The CD4+ T-cell absolute count identifies a specific
level of immune suppression, but changes with age.
The CD4+ T-cell % that defines each immunologic
category does not change; CD4 >25% is normal,
while CD4 <15% defines severe immune
suppression (Table on the next slide). CD4 % is
thus the preferred immunologic marker for
monitoring disease progression in children. Table
2.1. Immunologic Classification for HIV-Infected
Infants and Children

14. Mechanism for Decline in CD4 Count
Several mechanisms are involved in causing the decline in
CD4 count. These include: -
1. CD4 T-cell depletion through single-cell killing caused by
accumulation of HIV DNA in the cell or by inhibition of cell
function.
2. Cell membranes of infected cells fusing with cell
membranes of uninfected cells (syncytium induction),
resulting in giant multi-nucleated cells that are readily
destroyed by the immune system.

15. Cont.
3. Programmed death (apoptosis) also contributes to T-cell
depletion. It is postulated that cross-linking of the CD4
molecule with gp120anti-gp120 antibody complexes
programs the cell for death without direct infection of the cell
with HIV.
4. HIV infection induces neutralizing antibodies against
regions of the HIV envelope; these antibodies may play a role
in mediating antibody-dependent cellular toxicity after
binding to natural killer (cell killing) cells.
5. HIV specific cytotoxic T-cells (CD8 cells) also play a role in
killing HIV-infected cells.
These events contribute to depletion of CD4 cells and
deteriorating immune function.

16. Epidemiology
Human Immunodeficiency Virus (HIV) is without a doubt
one of the most serious conditions affecting the human
population in the 21st century).
According to the recent late 2016 statistics from World
Health Organization (WHO), 36.7 million people
worldwide are currently living with HIV1,2. Of all the
regions, one of the most heavily affected is sub-Saharan
Africa where approximately 1 in every 25. is currently
living with HIV, accounting for roughly two thirds of all
individuals currently living with HIV worldwide1.

17. • As the number of HIV cases increased, an epidemic was
announced in 1984 but origin of HIV, Largely unknown-
first seen in 1981, when the National Cancer Institute
announced the cause of HIV, the retrovirus HTLV-III
leading to Acquired Immune Deficiency Syndrome
(AIDS). This has since become a worldwide pandemic
with over 2 million newly infected individuals in 2015,
including 150,000 children (<15 years old).
• Thought to have entered humans as a zoonosis of SIV
• Of the high rates of HIV infections in Sub-Saharan Africa,
the country of Uganda is of a particular interest. During
the period of 2005 and 2013, the number of new HIV
infections in Uganda increased by 10%

18. • According to recent UNAIDS data, approximately 570 young
women aged 15 to 24 get infected with HIV every week in
Uganda.
• In all of Africa, Uganda is only second to South Africa where
2,363 individuals get infected every week. In 2013,
• Uganda combined with Nigeria and South Africa accounted for
almost 48% of all the new HIV cases in sub-Saharan
Africa.Despite this data,
• Uganda is one of only few countries in the world that has
managed to reverse its HIV epidemic. With reported prevalence
rates of 18–30% in the 1990s,
• Uganda was one of the highest in the world. Late 2000s statistics
showed a drastically decreased prevalence rate hovering around
6.5%2. However, reports in 2012 suggested that Uganda was one
of only two African countries where rates of new HIV infections
were back on the rise. This resulted in an increased prevalence
rate of up to 7.3%

19. Prevalence In Uganda.
Uganda (6.2%);- 7.6% among females and 4.7%
among male.
Children below the age of 15 account for 11% of
1.6million Ugandan living with HIV(2013 W.H.O).
With the roll-out of option B+ There has been
significant drop in new mother-to-child HIV
infections, from 8.7% in September 2012 to 7.9% in
2017.
(UNAIDS Estimates).

20. Children with HIV/AIDS
Most infections in HIV positive children are caused by
the same pathogens as in HIV negative children
although they may be more frequent, more severe and
occur repeatedly.
Many HIV + children die from common childhood
illnesses and some of these death are preventable by
early diagnosis and correct management or by giving
routine scheduled vaccinations and improving
nutrition.
These children have a particularly great risk for
staphylococcal and pneumococcal infections and TB .
Saving children's live depends on early identification,
immediate treatment with ART and co-trimoxazole
prophylaxis for those who are HIV infected.

21. All infants and children should have their HIV status
established at their first contact with the health
system. Ideally at birth or at the earliest
opportunity thereafter. To facilitate , all areas of the
hospital in which maternal, neonatal and child
services are delivered should offer HIV serological
testing to mothers and their infants and children

22. Clinical experience indicates that children
infected with HIV perinatally who are not
on ART fit into one of these three
categories:
1. Those with rapid progress (25-30%)most of whom die
before their first birthday they are thought to have
acquired the infection in utero or during the early
postnatal period.
2. Children who develop symptoms early in life the
follow a down hill course and die at age 3-5yrs (50-
60%)
3. Long term survivors who lived beyond 8yrs of age (5-
25%) they tend to have lymphoid interstitial
pneumonitis and stunting with low weight and height
for age.

23. Signs that may indicate possible
HIV infection in children:-
1. Recurrent infections, three or more severe
episodes of a bacterial infections such as pneumonia,
meningitis, sepsis, cellulitis in the past 12month
2. Oral thrust, erythema and white-beige pseudo
membranous plaques on the plate, gums and buccal
mucosa. After the neonatal period , the presence of
oral thrust is highly suggestive of HIV infection when
it last >30days despite antibiotic treatment

24. 3. Chronic parotitis , unilateral or bilateral parotid swelling
for >=14days with or with out associated pain or fever.
4. Generalized lymphadenopathy
5. Hepatomegaly with no apparent cause.
6. Persistent and or recurrent fever (>38 degrees c) lasting
>=7days or occurring more than once over 7days.
7. Neurological dysfunction, progressive neurological
impairment, microcephaly, delayed developmental
milestone, hypertonia, or mental confusion.
8. Herpes zoster(shingle), painful rash with blister confined
to one dermatome on one side
9. HIV dermatitis, erythematous popular rash, typical skin
rash i include extensive fungal infection of the skin, nail, and
scalp and extensive molluscum contagiosum
10. Chronic supportive lung disease.

25. Above where the possible indicators for HIV infection in a
child thus once you notice any please carry out laboratory
investigation to R|o HIV infection.

26. Signs common in HIV-infected children, but
also common in ill non-HIV infected children
1. Chronic otitis media: ear discharge lasting ≥14 days.
2. Persistent diarrhea: diarrhea lasting ≥14 days.
3. Moderate or severe malnutrition: weight loss or a gradual
but steady deterioration in weight gain from the expected
growth, as indicated in the child’s growth card. Suspect HIV
particularly in breastfed infants <6 months old who fail to
thrive.

27. Signs or conditions very specific to
HIV-infected children
Strongly suspect HIV infection if the following are
present:
1. pneumocystis pneumonia (PCP),
2. esophageal candidiasis,
3. lymphoid interstitial pneumonia (LIP)
4. Kaposi’s sarcoma.
5. Acquired recto-vaginal fistula in girls is also very
specific but rare.
These conditions are very specific to HIV-infected
children.

31. Cutaneous fungal infections photo from jinja reg ref hospital ( JRRHOSP)by
mwebaza victor

33. Herpes simplex: Gingivostomatitis photo from jinja reg ref hosp (JRRHosp) by mwebaza victor

35. White verrucous plaques on lateral aspect of the tongue at Jinja hosp image by
mwebaza victor

36. Human papilloma virus
Causes Warts; relatively
common in children
Verrucous papules; smooth,
flat or pedunculated
Affect feet, hands, face,
genitalia.
Treatment: cryosurgery

38. Bacterial infections of skin
Staph. aureus and Strep.
pneumoninae.
Impetigo, folliculitis,
abscesses, infected
wounds, cellulitis.
More frequent than non-
infected children

39. Testing and diagnosis of HIV
infection in children
The diagnosis of HIV infection in perinatally exposed
infants and young children is difficult because passively
acquired maternal HIV antibodies may be present in the
child’s blood until the child is 18 months of age.
Additional diagnostic challenges arise if the child is still
breastfeeding or has been breastfed.
Although HIV infection cannot be ruled out until 18
months for some children, many children will have lost
HIV antibodies between 9 and 18 months.
HIV testing should be voluntary and free of coercion, and
informed consent is required before HIV testing

40. Cont..
All diagnostic HIV testing of children must be:
1. Confidential
2 . Be accompanied by counselling
3. Only be conducted with informed consent so that
it is both informed and voluntary.
For children this usually means parental or guardian’s
consent. For the older minor, parental consent to
testing/treatment is not generally required; however
it is obviously preferable for young people to have
their parents’ support, and consent may be required
by law. Accepting or refusing HIV testing should not
lead to detrimental consequences to the quality of
care offered.

41. Virological testing or DNA-PCR
Virological testing for HIV-specific RNA or DNA is the most
reliable method for diagnosing HIV infection in children <18
months of age. 1st DNA-PCR at 6 weeks of age: if positive, stop
NVP and initiate regular HAART.
If the child has had zidovudine (ZDV) prophylaxis or Daily
nevirapine until at least 2 weeks during and after delivery,
virological testing is not recommended until 4–8 weeks after
delivery, as ZDV interferes with the reliability of the test.
1. One virological test which is positive at 4–8 weeks @6weeks
is sufficient to diagnose infection in a young infant.
2. If the young infant is still breastfeeding, and the RNA
virological test is negative, it needs to be repeated 6 weeks
after the complete cessation of breastfeeding to confirm
that the child is not HIV infected.
3. If PCR positive, start HAART and continue breastfeeding as
recommended

42. HIV antibody test (ELISA or rapid tests)
Rapid tests are increasingly available and are safe, effective,
sensitive and reliable for diagnosing HIV infection in children
from the age of 18 months and above.
For the children <18 months, rapid HIV antibody tests are
a sensitive, reliable way of detecting the HIV exposed
infant and to exclude HIV infection in nonbreastfeeding
children.
You can use rapid HIV tests to exclude HIV infection in a child
presenting with malnutrition or other serious clinical events
in high HIV-prevalence areas. For children <18 months,
confirm all positive HIV antibody tests by virological tests as
soon as possible (see above). Where this is not possible,
repeat antibody testing at 18 months.

43. Diagnosis: older children >18
months
1. Rapid test: DETERMINE → STATPAK → UNIGOLD;
2. If positive, start HAART
NB: The above rapid test is also applicable to the
mother

44. The WHO pediatric clinical staging system
• For use in those <13 years with confirmed laboratory evidence
of HIV infection (HIV AB where age >18 months, DNA or RNA
virological testing for those age <18 months)
STAGE 1
 Asymptomatic
Persistent generalized lymphadenopathy (PGL)
STAGE 2
Hepatosplenomegaly
Parotid enlargement
 Papular pruritic eruptions
Seborrhoeic dermatitis
 Fungal nail infections

45. Angular cheilitis
Lineal gingival erythema (LGE)
Extensive human papilloma virus infection or
molluscum infection (>5% body area)
Recurrent oral ulcerations (2 or more episodes in 6
months)
 Herpes zoster Recurrent
Chronic upper respiratory tract infections (otitis
media, otorrhoea, sinusitis, 2 or more episodes in
any 6 month period

46. STAGE 3
Unexplained moderate malnutrition not responding to
standard therapy
 Unexplained persistent diarrhoea (>14 days) Unexplained
persistent fever (intermittent or constant, for longer than 1
month)
Oral candidiasis (outside neonatal period)
Oral hairy leukoplakia
 Pulmonary tuberculosis
 Severe recurrent presumed bacterial pneumonia (2 or more
episodes in 6 months)
Acute necrotizing ulcerative gingivitis/periodontitis
 LIP (lymphoid interstitial pneumonia)
Unexplained anaemia (<8 gm/dl), neutropenia (<500/mm3) or
thrombocytopenia (<30,000/mm3) for >1 month.

47. STAGE 4
HIV/AIDS Unexplained severe wasting or severe
malnutrition not responding to standard therapy
Pneumocystis pneumonia
Recurrent severe presumed bacterial infections (2 or more
episodes within one year, e.g. empyema, pyomyositis, bone
or joint infection, meningitis, but excluding pneumonia )
 Chronic orolabial or cutaneous herpes simplex infection (of
>1 month duration)
Disseminated or extrapulmonary tuberculosis
Kaposi sarcoma
 Oesophageal candida

48. Symptomatic HIV seropositive infant <18 months
with 2 or more of the following; -
1. oral thrush,
2. severe pneumonia,
3. failure to thrive,
4. severe sepsis
• CMV retinitis
• CNS toxoplasmosis
• Any disseminated endemic mycosis including cryptococcal
meningitis (e.g. extra-pulmonary cryptococcosis,
histoplasmosis, coccidiomycosis, penicilliosis)
Cryptosporidiosis or isosporiasis (with diarrhoea >1 month)
• Cytomegalovirus infection (onset at age >1 month in an
organ other than liver, spleen, or lymph nodes).

49. • Disseminated mycobacterial disease other than
tuberculous
• Candida of trachea, bronchi or lungs
• Acquired HIV-related recto-vesico fistula
• Cerebral or B cell non-Hodgkin’s lymphoma
• Progressive multifocal leukoencephalopathy (PML)
• HIV encephalopathy
• HIV-related cardiomyopathy HIV-related
nephropathy

50. NOTICE:-
1. TB may occur at any CD4 count and CD4 % should
be considered where available.
2. Presumptive diagnosis of stage 4 disease in
seropositive children <18 months requires
confirmation with HIV virological tests or using HIV
antibody test after 18 months of age.

51. • ANTIRETRO VIRAL THERAPY
• The underlying principles of antiretroviral therapy (ART)
and choice of firstline ART in children are largely the
same as in adults. However it is also important to
consider:-
• availability of a suitable formulation that can be taken in
appropriate doses •
• simplicity of the dosage schedule •
• taste/palatability and hence compliance in young children
•
• the ART regimen which the parent(s) or guardians are or
will be taking.
• Suitable formulations for children are not available for
some ARVs (particularly the protease inhibitor class of
drugs).

54. • Antiretroviral drugs
• Antiretrovirals fall into three main classes of drugs:
nucleoside analogue reverse transcriptase inhibitors (NRTIs)
• , non-nucleoside reverse transcriptase inhibitors (NNRTIs),
• and protease inhibitors (PIs).
• Triple therapy is the standard of care. WHO currently
recommends that firstline regimens should be based upon
two nucleoside analogue reverse transcriptase inhibitors
(NRTI) plus one non-nucleoside drug (NNRTI).
• The use of triple NRTI as first-line therapy is currently
considered a secondary alternative because of recent
research findings in adults. Protease inhibitors

57. • When to start ART
• For infants and children with confirmed HIV
infection, the indications for starting treatment are
outlined in Table below.
• In children aged 12–18 months who are HIV
(antibody) positive, with symptoms and in whom
HIV is strongly suspected on clinical grounds, it may
be reasonable to start ART.
• Starting ART in asymptomatic children is not
encouraged because of inevitable development of
resistance with time.

58. • Treatment should generally be deferred until after
acute infections have been treated. In the case of
tuberculosis which is frequently (but generally only
presumptively) diagnosed in HIV-infected children,
treatment should be deferred at least until after 2
months of antituberculous therapy has been
completed, and preferably until completion of all
antituberculosis therapy. This is to avoid
interactions with rifampicin and also possible non-
adherence due to the number of medications
needed to be administered. Choice of ART is similar
to that in adults.

61. • Side-effects of antiretroviral therapy and monitoring
• HIV/AIDS The response to antiretroviral treatment and
side-effects of treatment need to be monitored.
• Where CD4 cell count is available, this should be done
every 3-6 months and can inform on the successful
response to treatment or its failure and therefore guide
changes in treatment. Where this is not possible, clinical
parameters, including clinical staging events, need to be
used
• Monitoring response after ARV initiation: •
• After ARV initiation or ARV change:
• — See the child at 2 and 4 weeks after the start/change.
• Child should be seen if there are any problems

62. • General, long-term side-effects of antiretroviral
therapy include lipodystrophy.Specific side-effects
of individual antiretroviral drugs are summarized in
Table next slide.

65. • Long-term follow-up
• A clinician should see the child at least every 3 months.
• A non-clinician (ideally, the provider of ARV medication,
such as pharmacist, who would assess adherence and
provide adherence counselling) should see the child
monthly.
• Child should be seen more frequently, preferably by a
clinician, if clinically unstable.

66. • The organization of follow-up care depends on the local
expertise, and should be decentralized as far as
possible. Monitoring response
• Weight and height (monthly)
• Neurodevelopment (monthly)
• Adherence (monthly)
• CD4 (%) if available (then every 3–6 months) •
• Baseline Hb or Hct (if on ZDV/AZT), ALT if available.
• Symptom-related determination: Hb or Hct or full blood
count, ALT

67. • When to change treatment
• When to substitute
• Drugs need to be substituted for others when
there is :-
• Treatment limiting toxicity, such as:-
• — Stevens Johnson Syndrome (SJS)
• — Severe liver toxicity
• — Severe haematologic findings
• Drug interaction (e.g. tuberculosis treatment with
rifampicin interfering with NVP or PI)
• Potential lack of adherence by the patient if he/she
cannot tolerate the regimen.

68. Stevens–Johnson syndrome, a form of toxic
epidermal necrolysis, is a life-threatening skin
condition

70. Supportive care for HIV
positive children
• 1.Immunization
• Children who have, or are suspected to have, HIV
infection but are not yet symptomatic should be given
all appropriate vaccines (according to the national EPI
programme schedule), including BCG and, where
relevant, yellow fever vaccine. Because most HIV-
positive children have an effective immune response in
the first year of life, immunization should be given as
early as possible after the recommended age of
vaccination.
• Do not give BCG and yellow fever vaccines to
children with symptomatic HIV infection.
• Give all children with HIV infection (regardless of
whether they are symptomatic or not) an extra dose of
the measles vaccine at the age of 6 months, as well as
the standard dose at 9 months.

73. • 2. Co-trimoxazole prophylaxis

80. 3. Nutrition

81. • For infants confirmed zero negative but the mother
being HIV positive, the infants are breast fed for
6weeks then complimentary feeds introduced
• However for sero + baby and mother :-Ebf for
6month then mixed bf up to 2yrs.

83. Management of HIV related
conditions

84. • Tuberculosis

88. • Treat tuberculosis in HIV-infected children with the
same anti-tuberculosis drug regimen as for non-
HIV-infected children with tuberculosis, but replace
thioacetazone with an alternative antibiotic (refer
to national tuberculosis guidelines or see section
4.7, page 101).
• Note: Thioacetazone is associated with a high risk
of severe, and sometimes fatal, skin reactions in
HIV-infected children. These reactions can start
with itching, but progress to severe reactions.
• If thioacetazone must be given, warn the parents
about the risk of severe skin reactions and advise
them to stop thioacetazone at once, if there is
itching or skin reactions occur.

89. • Pneumocystis jiroveci (formerly carinii) pneumonia
(PCP)
• Make a presumptive diagnosis of pneumocystis
pneumonia in a child who has severe or very severe
pneumonia and bilateral interstitial infiltrates on
chest X-ray. Consider the possibility of pneumocystis
pneumonia in children, known or suspected to have
HIV, whose ordinary pneumonia does not respond to
treatment.
• Pneumocystis pneumonia occurs most frequently in
infants and is often associated with hypoxia. Fast
breathing is the most common presenting sign,
respiratory distress is out of proportion with chest
findings, fever is often mild. Peak age is 4–6 months.

91. • ➤Promptly give oral or preferably IV high-dose
cotrimoxazole (trimethoprim (TMP) 8 mg/kg/dose,
sulfamethoxazole (SMX) 40 mg/kg/dose) 3 times a day for
3 weeks.
• ➤If the child has a severe drug reaction, change to
pentamidine (4 mg/kg once per day) by IV infusion for 3
weeks.

92. • Lymphoid interstitial pneumonitis(LIP)

93. • Management:-
• Give a trial of antibiotic treatment for bacterial
pneumonia before starting treatment with prednisolone.

94. • Give oral prednisone, 1–2 mg/kg daily for 2 weeks.
Then decrease the dose over 2–4 weeks depending
on treatment response.

95. • X-ray

96. Fungial infection

100. Karposis sarcoma

102. Prevention of mother-to-child
transmission .To be discussed, for more
information

105. Infant feeding in the context of
HIV infection.

109. Adolescent Issues
• Adolescents Requiring HIV-Related Services
• There are different categories of adolescents requiring HIV
services:
• 1. HIV-infected adolescents: This group includes long-term
survivors of mother-to-child transmission of HIV and youths
infected during childhood or adolescence through sexual
exploitation or from their own high-risk behaviour.
• 2. Youth engaging in high-risk behaviour: Increasing poverty
and dissolution of families as parents die can also lead to
increasing numbers of female and male youth engaging in
survival sex. These high-risk activities put the adolescents at risk
of HIV infection.
• 3. Youth in long-term relationships: One of the ultimate tasks
of adolescents’ development is being able to have mutually
supportive, mature, intimate relationships that naturally lead to
long-term relationships, even marriage. Many adolescent
women acquire HIV from their husbands.

110. • Behavioural factors, particularly sexual activity,
increase the risk of transmission among adolescents.
• It is estimated that up to two-thirds of the new HIV
infections occr in those younger than 25 years of age
(UNAIDS). There is a Simple evidence that
adolescents are engaging in sexual risk taking: -
• 1. On average one-third of first-born babies in the
region are born to adolescent women. •
• 2. Half the women seeking abortion-care services in
public hospitals are adolescent girls.
• 3. Many girls continue to drop out of school because
of unwanted pregnancies.

111. • Boys tend to initiate sex earlier compared to girls,
and rural youth are more likely to be sexually
active than urban youth, girls are more vulnerable
to heterosexual transmission of HIV than boys.

120. • Phionah Nakyeyune from mityana Uganda , HIV +ve
but with health HIV -be baby .report being defiled
by her uncle when she was 10yrs and he did this act
for more than 5 times and he used to scare her that
if she tell any one she will be kill. So she ended up
being used by her uncle who was HIV POSITIVE.
After agross period of time she became pregnant
and when the mother noted it l, because of
povertythe uncle scared the mother too since
phionah and the mother where obtaining Aid from
this man. So she committed ABORTION at 13yrs
• Around her 14yr birth day she became severely sick
and when they went to hospital she was found to
have HIV.
• Phionah underwent couselling and she started
taking her ARVs well .
• Now she's 34yrs old and gave birth to a HIV-ve baby
girl in a health center where she get her ARVs.

121. Phionah
Nakyeyune with
her HIV-ve baby

122. • Follow-up
• Discharge from hospital
• HIV-infected children may respond slowly or
incompletely to the usual treatment.
• They may have persistent fever, persistent
diarrhoea and chronic cough. If the general
condition of these children is good, they do not
need to remain in the hospital, but can be seen
regularly as outpatients.

123. • Referral
• If facilities are not available in your hospital, consider
referring a child suspected to have HIV infection: -
• 1. For HIV testing with pre- and post-test counselling
• 2. To another centre or hospital for further investigations or
second-line treatment if there has been little or no response
to treatment
• 3. To a trained counsellor for HIV and infant feeding
counselling, if the local health worker cannot do this
• 4. To a community/home-based care programme, or a
community/institutionbased voluntary counselling and
testing centre, or a community-based social support
programme for further counselling and continuing
psychosocial support.
• A special effort should be made to refer orphans to essential
services including health care education and birth
registration.

124. • Clinical follow-up
• Children who are known or suspected to be HIV-
infected should, when not ill, attend well-baby
clinics like other children.
• In addition, they need regular clinical follow-up at
first-level facilities at least twice a year to monitor:-
• — their clinical condition
• — growth
• — nutritional intake
• — immunization status
• — psychosocial support (where possible, this
should be given through community-based
programmes).

125. References for Mwebaza's
presention:-

126. E N D
• "If I can stop one heart from breaking I shall
not live in vain; if I can stop one life the
aching or cool one pain, or help one fainting
robin unto its nest again, I shall not live in
vain.
• - MWEBAZA VICTOR
• GOD BLESS YOU.