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Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
Pediatric HIV/AIDS
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Pediatric HIV/AIDS

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  • 1. Pediatric HIV/AIDS Nikki Dieker
  • 2. AIDS Statistics <ul><li>Today 40 million people are estimated to be living with HIV/AIDS including 3 million children </li></ul><ul><li>During 2001, AIDS caused the deaths of roughly 3 million people including 580,000 children </li></ul><ul><li>95% of the people that have HIV live in the developing world </li></ul>CDC Division of HIV/AIDS Prevention
  • 3. HIV/AIDS Statistics Cont <ul><li>Half of the 5 million new infections in the past year occurred among individuals between 15 and 24 years of age </li></ul><ul><li>In the United States one quarter of new infections occur in youths age 13-21 at a rate of one new infection every hour </li></ul>Children’s Friends for Life
  • 4. AIDS Orphans <ul><li>Includes children who have lost either their father, mother, or both to AIDS </li></ul><ul><li>By 2010 there will be 25 million living AIDS orphans </li></ul><ul><li>Earlier estimates put the number at 40 million, but it does not take into account the 15 million AIDS orphans that will die in the next 8 years </li></ul>UNICEF and UNAIDS
  • 5. Mother to Infant Transmission <ul><li>Without interventions 35% of infants born to HIV-positive mothers will contract HIV </li></ul><ul><li>Of these: </li></ul><ul><ul><li>15-20% occur during pregnancy </li></ul></ul><ul><ul><li>50% occur during labor and delivery </li></ul></ul><ul><ul><li>33% occur during breastfeeding </li></ul></ul>
  • 6. The Breastfeeding Dilemma <ul><li>Infants can contract HIV through breastfeeding </li></ul><ul><li>In developing countries formula is often not available or extremely expensive </li></ul><ul><li>If formula is available, clean water often is not </li></ul>
  • 7. Diagnosis <ul><li>An infant less than 18 months of age is considered HIV-infected if they are seropositive, or were born to an HIV infected mother and has positive results on two separate HIV tests </li></ul><ul><li>An infant can be excluded by the disappearance of anti-HIV antibody by 18 months of age (seroreversion) </li></ul>
  • 8. Major Problems Associated with HIV/AIDS <ul><li>Malnutrition </li></ul><ul><li>Growth failure </li></ul><ul><li>Developmental delays </li></ul><ul><li>Micronutrient deficiencies </li></ul><ul><li>Neurological problems </li></ul><ul><li>Opportunistic infections </li></ul><ul><li>Normal childhood illnesses are potentially fatal </li></ul>
  • 9. Problems Continued <ul><li>If you have a child with AIDS you generally have a family with AIDS </li></ul><ul><li>Socioeconomic status </li></ul><ul><li>Access to medication </li></ul>
  • 10. Malnutrition <ul><li>Impaired nutritional absorption </li></ul><ul><li>Increased nutritional requirements </li></ul><ul><li>Reduced food intake </li></ul>
  • 11. Impaired Nutritional Absorption <ul><li>HIV-induced diarrhea </li></ul><ul><li>Dehydration </li></ul><ul><li>Lactose intolerance </li></ul><ul><li>Opportunistic infections </li></ul><ul><ul><li>Cryptosporidioses </li></ul></ul><ul><ul><li>Tuberculosis </li></ul></ul><ul><li>Gastric acid hypersecretion </li></ul><ul><li>Drug interactions </li></ul>
  • 12. Increased Nutritional Requirements <ul><li>Metabolic activity changes </li></ul><ul><ul><li>Alterations in the function of the GI tract </li></ul></ul><ul><ul><li>Alteration in their ability to use food efficiently </li></ul></ul><ul><ul><li>Increased use of body fat stores </li></ul></ul><ul><ul><li>Recurrent fevers and infections </li></ul></ul><ul><ul><li>Depletion of vitamin and mineral stores </li></ul></ul><ul><li>Increased calorie needs </li></ul>
  • 13. Reduced Food Intake <ul><li>Partially due to neurological involvement </li></ul><ul><ul><li>Abnormal swallowing mechanisms </li></ul></ul><ul><ul><li>Gastroesophageal reflux </li></ul></ul><ul><ul><li>Aspiration </li></ul></ul><ul><ul><li>Decrease in taste and appetite </li></ul></ul><ul><ul><li>Regression of eating skills </li></ul></ul><ul><li>Oral lesions and HIV-specific gingivitis and gum disease </li></ul><ul><li>Drug induced nausea, gastric irritation and drug volume and schedules </li></ul><ul><li>Psychological problems such as depression </li></ul>
  • 14. Neurological and Developmental Problems <ul><li>Impaired brain growth </li></ul><ul><li>Progressive motor dysfunction </li></ul><ul><li>Loss or leveling out of developmental milestones </li></ul><ul><li>Seizures </li></ul><ul><li>Strokes </li></ul>
  • 15. Nutrient Deficiencies <ul><li>Vitamin A (18-50%) </li></ul><ul><li>Vitamin E (27%) </li></ul><ul><li>Vitamin C (7%) </li></ul><ul><li>Riboflavin (26%) </li></ul><ul><li>Vitamin B6 (53%) </li></ul><ul><li>Vitamin B12 (23%) </li></ul><ul><li>Copper (74%) </li></ul><ul><li>Zinc (50%) </li></ul><ul><li>Selenium (10%) </li></ul>
  • 16. Nutritional Assessment <ul><li>Detailed diet history </li></ul><ul><li>Medication history </li></ul><ul><li>Anthropometric data </li></ul><ul><li>Evaluation of weight changes </li></ul><ul><li>Laboratory data </li></ul>
  • 17. What can be done? <ul><li>Early culturally acceptable dietary intervention may help avoid growth failure </li></ul><ul><li>Small frequent feedings </li></ul><ul><li>Nutrient supplementation </li></ul><ul><li>Soft-textured, moist foods, at room temperature (casseroles, eggs, pasta, and gravy on meats) </li></ul><ul><li>Fluids may be tolerated better through a straw </li></ul>
  • 18. What can be done? <ul><li>A tolerable anti-HIV regimen including a combination of three different medications, two reverse transcriptase inhibitors and a protease inhibitor can cause weight gain, improved mental functioning and a longer life </li></ul><ul><li>Aggressive treatment of opportunistic infections can prevent the deterioration of nutritional status </li></ul><ul><li>Estimate energy needs using a Metabolic Cart, RDA tables or the Bentler and Stannish formula for catchup growth </li></ul><ul><ul><li>May be up to 200 kcal/kg and 4g protein/kg </li></ul></ul>
  • 19. What can be done? <ul><li>Evaluate feeding skills to see if tube feeding is necessary or total parenteral nutrition is necessary </li></ul><ul><li>For diarrhea: </li></ul><ul><ul><li>Lactaid milk and yogurt products </li></ul></ul><ul><ul><li>Soy milk </li></ul></ul><ul><ul><li>Soluble forms of fiber (oatmeal, rice, bananas, applesauce) </li></ul></ul><ul><ul><li>Replace fluid loss with electrolyte solutions such as Pedialyte </li></ul></ul>
  • 20. Tips for Caregivers <ul><li>Watch for any changes in your child’s behavior </li></ul><ul><li>Talk to your doctor before you give your child any immunizations or booster shots </li></ul><ul><li>Plastic and washable toys are preferred </li></ul><ul><li>Food safely is vital </li></ul><ul><li>These children need a lot of love, don’t be afraid to touch them </li></ul>
  • 21. Reference <ul><li>Eley B, Hussey G. Nutrition and human immunodeficiency virus in children. SA J Clin Nutr. 1999;89:190-195. </li></ul>
  • 22. Any Questions?

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