AIDS in children

1. MANAGEMENT
OF CHILD WITH
HIV/ AIDS

2. Mother-to-child transmission of HIV is the spread
of HIV from a woman with HIV to her child during
pregnancy, childbirth (also called labor and delivery),
or breastfeeding (through breast milk).

3. Mode of transmission
Transmission
Horizontal
(Responsible for 10-15%
cases)
Vertical
(Responsible for 90%
cases)
Transmission by:
•Sexual intercourse
•Needle Stick Injury
•Contaminated blood
Tranmission:
•In utero (30-35%)
•During delivery (60-65%)
•Breast feeding (1-3%)

4. WHO Clinical case
Definition for
pediatric AIDS
• Major signs:
– Weight loss or abnormally slow growth
– Chronic diarrhea of more than 1 month duration
– Prolonged fever of more than 1 month duration

5. Cont..
• Minor signs
– Generalized lymphadenopathy
– Oropharyngeal candidiasis
– Repeated common infections
– Persistent cough
– Generalized dermatitis
– Confirmed maternal HIV infection

6. Definition
According to WHO, ‘pediatric AIDS is suspected in
a child presenting with at least 2 major signs
associated with 2 minor signs in the absence of
known causes of immune suppression such as
cancer, malnutrition or other recognized etiologies.

7. Clinical Course of
Vertically Aquired
HIV Infection
At birth HIV infected infants are generally
asymptomatic. After that the clinical disease may
appear in 2 forms:
1. Rapidly progressive form (present in 80%cases)
2. Slow progressive form (present in 20%cases)

8. Cont..
1. Rapidly progressive form-
• Symptoms occur within 3-4 months of age
• Pneumonia is the presenting illness in most cases
• Other cases may present with lymphadenopathy,
hepatospleenomegaly, growth failure,
encephalopathy etc.

9. Cont..
2. Slow progressive form-
• Child may present as late as 8 years of life
• Most presenting feature is lymphocytic interstitial
pneumonia (LIP)

10. CLINICAL STAGING
ACCORDING TO WHO
STAGE 1
• Asymptomatic
• Persistent generalised lymphoadenopathy

11. STAGE 2
• Papular pruritic eruptions
• Fungal nail infection
• Angular chielitis
• Recurrent oral ulceration
• Recurrent URTI

12. STAGE 3
• Unexplained moderate malnutrition
• Unexplained persistent diarrhea (14 days or more)
• Unexplained persistent fever ( above 37.5°C intermittent or
constant, for longer than 1 month).
• Persistent oral candidiasis (after 6-8 weeks of life)
• Acute ulcerative periodontitis
• Severe recurrent bacterial pneumonia
• Symptomatic lymphoid interstitial pneumonitis

13. STAGE 4
• Unexplained severe wasting, severe malnutrition not
responding to standard therapy.
• Pneumocystis pneumonia
• Recurrent severe bacterial infections
• Chronic herpes simplex infection
• Esophageal candidiasis

14. DIAGNOSIS
1. Nucleic acid tests (NATs) — detects HIV ribonucleic acid
(RNA)
2. Antibody tests — detects HIV IgM or IgG antibodies
3. ELISA
4. Western blot method
5. PCR
6. CD4 cell count

15. Normal CD4 count for
children
Age CD4 Count
< 12 months CD4 >1500 cells/mm cube
1-5 years CD4 >1000 cells/mm cube
> 5 years CD4 >550 cells/mm cube

16. NURSING CARE OF
CHILD WITH AIDS
✓ Zidovudine is the drug of choice as ART for children.
✓ Wear gloves while changing diapers
✓ Good hand washing practice
✓ Barrier nursing for child
✓ Only killed vaccine should be administered
✓ Lactose free diet should be given
✓ Bland diet can be given for child with oral lesions
✓ Skin care should be provided to the child suffering from
diarrhea

17. PREVENTION OF
VERTICAL
TRANSMISSION
Universal precautions
1. Wear double gloves, goggles, plastic apron, long
gown, mask, cap & overshoes (boots) during
delivery.
2. Protection from blood & amniotic fluid splash.
3. Minimal use of needles & sutures.

18. Cont..
4. Proper disinfection of gowns, gloves, masks, caps,
goggles & shoes.
5. Proper disinfection of floor, labour table &
mattresses or rubber used.
6. Proper disposal of blood, placenta and cord by
incineration.

19. INTRAPARTUM
MANAGEMENT
1. Elective LSCS reduces perinatal transmission upto
50-80%.
2. LSCS may increase the morbidity to
immunocompromised mother.

20. Cont..
During Delivery:
1. To take precaution for personal safety, to prevent
spread, to decrease perinatal transmission.
2. Avoid Vaginal tears
3. Avoid Instrumental delivery
4. Restrict Episiotomy

21. POSTPARTUM
MANAGEMENT
1. Wash newborn after birth, especially face.
2. No mouth to mouth breathing
3. Avoid hypothermia
4. Anti Retroviral Therapy (ART)

22. Anti-retroviral
Therapy
(Zidovudine)
1. Antepartum : oral AZT 100 mg 5 times a day starting
anytime from 14-34 wks & continued till delivery.
2. Intrapartum : I/V AZT 2mg/kg is given in 1st hour of
labor followed by 1 mg/kg/hour till delivery.
3. Postpartum : To the neonate, 2mg/kg birth weight
every 6 hours for 6 weeks beginning 8-12 hours after
birth.

23. Prevention of
horizontal
transmission
1. Universal precautions must be taken while caring for the
child
2. Only screened blood and blood products should be
administered to the child
3. Sterile and disposable needles and syringes must be
used for children
4. Post exposure prophylaxis must be given