Aids in children.pptx

1. HIV/AIDS
IN children
By: Archana Maletha
Assistant Professor (CHN)
Class: M.Sc. (N) 2nd year

2. INTRODUCTION
What is H.I.V?
Human Immuno deficiency Virus
H- Infects only Human beings
I- Immunodeficiency Virus weakens the immune
system and increases the risk of infection
V- Virus that attaks body

3.  What is AIDS?
Acquired Immune Deficiency Syndrome
A- Acquired, not inherited
I- weakens the Immune System
D- creates a Deficiency of CD4+ cells in the
immune system
S- Syndrome, or a group of illness taking place
at the same time

4. DEFINITION
HIV is a unique type of virus (retrovirus) that
invades the T-helper cells(CD4) in the body of
the host ( defiance mechanism of a person).
AIDS is a disease of the human immune
system caused by infection with human
immunodeficiency virus. In the children it is
acquired prenatally or by vertical-maternal-
infant transmission.

5. INCIDENCE
According to W.H.O.
 2.3 Million children below 15 yrs are affected
i.e. 77% of the world population
 Globally 91% from vertical transmission
 5% from nosochrombial transmission
 4% from sexual abuse

6. MODE OF TRANSMISSION
 About 91% of cases of HIV/AIDS among
children are acquired from infected mother
resulting in vertical transmission
 Vertical transmission from mother to child may
occur
- in uterus 30 – 35%
- during delivery 60 – 65%
- through breastfeeding 3-10%
 Retro virus is found in blood, semen, vaginal
secretions and in the breast milk

7. …cont
Horizantal transmission of HIV occurs through
 Sexual intercourse
 Needle sticks
 Transmission of contaminated blood and blood
products
 Parenatal exposure to body fluids
 HIV is not transmitted through food, water,
mosquitoes, casual contacts such as shaking hand,
social kiss, hugging etc.

8. FACTOR CONTRIBUTE VERTICAL
TRANSMISSION
1. High levels of vermia with lack of matching antibody in the pregnant
women
2. Advanced material HIV infection
3. Low CD4 counts in the mother
4. Placental membrane inflammation
5. High CD8 counts
6. Premature babies
7. First born twins
8. Lack of antiviral therapy to infected pregnant wpmen
9. Breastfeeding along with formula milk

9. PATHOPHYSIOLOGY
• Human immunodeficiency virus primarily
causes the depletion of CD4 lymphocytes in
the blood and lymphnode
• These viruses makes CD4 lymphocytes to
replicate it causing it to be dysfunctional
• Gradually the CD4 lymphocyte count
decreases leading to progressive
immunodeficiency

10. Cont..
• When the CD4 cells falls below 200-400/ml
• Oppertunistic infections may occur and the
immune system is unable to cope with that
• Death occur due to infection, malignancy
or cachexia

11. CLASSIFICATION AND CLINICAL
MANIFESTATION
 Classified into four mutually exclusive category
based on parameters like infection status,
clinical status and immunological status.
 Once included in one particular category can’t
reclassified in less severe category even there
is improvement

12.  CATEGORY N: Children who are
asymptomatic or only have one of the
conditions in category A.
 CATEGORY A: Children with mild sign and
symptoms are included in this category.
Children who have two or more from the
conditions mentioned but non from category B
and C enter into category A. T

13.  The conditions are
• Lymphadinopathy
• Hepatomeghaly, spleenomeghaly
• Dermatitis
• Parotitis
• Recurrent upper respiratory infections,
sinusitis or otitis media

14. CATEGORY B( MODERATE S/s)
- Anaemia (hb below 8mg/dl)
- Neutropenia ( 1000/mm3 )
- Thrombocytopenia ( less than 1 lakh/mm3)
- Bacterial pneumonia, sepsis, meningitis
- Orophyngeal candidiasis
- Cardiomyopathy
- Cytomeghalovirus infection
- Persistant or recurrent diarrhea
- hepatitis
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15. - Stomatitis
- HSV Bronchitis, pneumonitis, esophagitis
- Herpes zoster infection
- Persistent fever
- Nephropathy
- toxoplasmosis

16. CATEGORY C ( Severe s/s)
- Severe recurrent multiple infection
- Esophageal or pulmonary candidiasis
- Disseminated coccidiomyosis
- CMV disease
- Cryptosporidiosis with diarrhea persisting for
more than one month
- Encephalopathy
- Histoplasmosis
- kaposi’s sarcoma

17. Con..
- Primary lymphoma in brain
- Non-typhoidal salmonella septicemia
- Toxoplasmosis of brain
- Persistent weight loss
- Chronic diarrhea
- Intermittent or recurrent fever

18. DIAGNOSTIC EVALUATION
ELISA ( Enzyme- Linked Immune Sorbent Assay)
- Only test HIV in serum not a diagnostic test for AIDS
WESTERN BLOT TEST
o This test is done if ELISA test is positive.
o Positive western blot test indicate that the person is exposed
toHIV and has antibodies.
o For AIDS the person should be examined for clinical
manifestation
Test for other STD.
BLOOD STUDIES: CD4 counts,direction of anti-HIV IgG (in case
of infection).

19. TREATMENT
◙ There is no any specific treatment for AIDS.
◙ Retroviral drugs can only suppress viral replication and modify course
of the disease.
◙ A combination of antiretroviral drugs is now preferred.
◙ Commonly used drugs include groups such as
- NRTIS ( Nucleoside analogue reverse transcriptase
inhibitors): Zidovudine ( AZT),
Lamivudine ( 3TC), Stavudine, Abacavir(ABC), Didanosine
zalcitabine.
- NNRTIS ( Non analogue RT’s ): Nevirapine (NVP),
Delavirdine (DLV), Efavirenz (EFV)

20. - PT ( Protease Inhibitors): Ritonavir (RTV), Indinavir
Saquinavir, Lopinavir, Nelfinavir, Amprenavir
◙ CD4 count is done to monitor the response to therapy.
◙ Syptomatic treatment is done with the following:
-analgesics
- antibiotics
- antifungal and antiprotozal agents
◙ Vaccines are under study
◙ Counselling and psychotherapeutic support.

21. PREVENTION

22.  Antiretroviral treatment with combination therapy or post
exposure prophylaxis to prevent HIV in child.
 Vertical transmission can be prevented by Zidovudine
prophylaxis to the infected pregnant women and to infant till 6
weeks of life.
 Health education to avoid blood brone HIV transmission.
 Parent to child transmission can be prevented by avoiding
indiscrimate sexual practices of adults.
 Heticulous screening of blood and blood products should be
done before blood transfusion.
 Sterilized syringe and needle should be used during
immunization.

23.  Aseptic technique should be used during delivery.
 Promoting community awareness of spread of HIV
infection for unsafe practices.
 Give only breastfeeding to baby upto 6 months. In
case of insufficient breast milk , give formula feeds but
do not give breast milk along with formula feed.
 Delivery by planned LSCS.

25.  Assess immunological status of child.
 Prevent spread of infection from external source to the child.
 Administer antiretroviral drugs as prescribed.
 Give supportive therapy as needed.
 Arrange for counselling and psychotherapy.
 Health education regarding transmission and control of
infections specially to adolescents and school age children.
 Teach them the precautions to be taken appropriate for their
age.

26.  Parents must be informed about the normal developmental
needs of these children, though some restrictions may be
necessary to limit exposure to source of infections.
 Ongoing education to community as well as to parents about
the myths and the social stigma which are painful to the child.
 Maintain confidentiality.
 Do not administer oral polio vaccine or BCG to child with
symptoms of HIV. Child can be safely given immunizations
such as triple antigen (DPT), hepatitis B, IPV and MMR.
 If case is vertical transmission encourage mother to receive
regular healthcare.

27. CONCLUSION
HIV is a retrovirus that is transmitted by
lymphocytes and monocytes. About 91% of
cases of HIV/AIDS among children are acquired
from infected mother resulting in a vertical
transmission.

28. SUMMARY