HIV AIDS in Child health nursing syllabus

1. CHILDREN WITH HIV/
AIDS

2. HIV/ AIDS – THE GLOBAL SCENARIO
 Worldwide, it has been estimated that 16.4 million
women and 1.4 million children less than 15 years of
age are living with HIV/AIDS.

3. EVOLUTION OF HIV IN INDIA
 First case was reported in Chennai in 1986.

4. PEDIATRIC HIV
 In the year 2007 it was estimated that more than
270,000 children less than 15 years of age lost their
lives due to AIDS related illnesses.
 About 4.3 million children less than 15 years of age
have died from AIDS since beginning of the
epidemic.

5. According to the AIDS Epidemic Update 2010, UNAIDS…..
 In India 202,000 children are infected by HIV/
AIDS.
 Based on HIV prevalence and pregnancy rate, 56,700
new HIV infected babies will be born every year in
India.

6. HIV / AIDS ?

7. H – Human
I – Immunodeficiency
V – Virus
 A retrovirus.
 Cannot be destroyed by the body.
 An infected person carries HIV for life.

8.  HIV (human immunodeficiency virus) is the virus
that causes AIDS (acquired immune deficiency
syndrome).
 The virus damages or destroys the cells of the
immune system, leaving them unable to fight
infections and certain cancers.

9. A – Acquired
I – Immune
D – Deficiency
S - Syndrome
 The collective presence of different opportunistic
infections, as a result of immune deficiency is known
as AIDS.

10. CAUSATIVE ORGANISM
 HIV is the primary cause of AIDS
 There are different strains of HIV. (HIV – 1 and HIV
– 2).

11. TRANSMISSION OF HIV / AIDS
• Through intimate sexual
contact or parenteral exposure
to blood or body fluids
containing visible blood.
Horizontal
transmission
• HIV infected pregnant woman
passes the infection to her
infant.
Vertical
transmission

12.  Vertical transmission can occur during the intrauterine
or intrapartum periods, or through breastfeeding.
 Upto 30% of newborns are infected in utero.
 Breastfeeding is an important route of transmission,
especially in the developing countries.

13.  According to WHO an estimated 430 000 children
were newly infected with HIV in 2010, over 90% of
them through mother-to-child transmission (MTCT).

14. PATHOPHYSIOLOGY
Such suppression of cell mediated immunity
places a person at risk for opportunistic infection.
The virus uses lymphocytes to replicate itself,
rendering these cells dysfunctional.
HIV primarily infects a specific subset of T-
lymphocytes, the CD4 T cells.

15. CD4 lymphocytes count gradually decreases over
time; at some point, physical symptoms appear.
An immune response follows, and the resulting
level of plasma virus is generally maintained for
years.
It also causes dysfunction of B cells and antigen
presenting cells, resulting in suppression of
humoral immunity.

16.  The count eventually reaches a critical level below
which there is substantial risk of opportunistic
illness followed by death.

17. CLINICAL MANIFESTATIONS
 Majority of infants with perinatally acquired HIV
infection are clinically normal during infancy,
developing symptoms by 18 – 24 months of age.

18. Common clinical manifestations
 Lymphadenopathy
 Hepatosplenomegaly
 Oral candidiasis
 Chronic or recurrent
diarrhea
 Developmental delay
 Parotitis
 Wasting and severe
malnutrition
 Recurrent bacterial
infections
 Neurological
deterioration

19. Opportunistic infections:
Pneumocystis pneumonia
Recurrent bacterial infections
Tuberculosis
Viral infections
Gastrointestinal disorders such as malabsorption.

20. PEDIATRIC HUMAN IMMUNODEFICIENCY VIRUS
CLASSIFICATION
 The CDC has developed a classification system to
describe the spectrum of HIV disease in children.
 The system indicates the severity of clinical signs/
symptoms and the degree of Immunosuppression.

21. CLINICAL CATERORIES
Immunologic
categories
N: No signs/
symptoms
A: Mild signs
/ symptoms
B: Moderate
signs / symptoms
C: Severe signs/
symptoms
No evidence
of
suppression
N1 A1 B1 C1
Evidence of
moderate
suppression N2 A2 B2 C2
Severe
suppression N3 A3 B3 C3

22. DIAGNOSIS
 All infants born to HIV infected mothers, test
antibody positive at birth because of passive transfer
of maternal HIV antibody across the placenta.

23. HIV INFECTED PREGNANT
MOTHER
HIV –exposed infant (breast fed and non breastfeed.
First HIV DNA PCR Symptomatic HIV exposed child < 18
months of age (not previously
diagnosed)
Repeat HIV DNA PCR to
confirm
Negative PCR test
+
+ _
Report
HIV
positiv
e
Repeat test and refer for
follow up
_
Breast fed Not Breast fed
Second PCR after 6 – 8
weeks of stopping
breastfeeding or earlier if
symptomatic
Second PCR at 6 months
to confirm status
+
Report HIV negative
_
Report test and refer
for follow up.
_ +

24. MANAGEMENT
 BEFORE PREGNANCY
 DURING PREGNANCY
 DURING LABOR
 AFTER DELIVERY

25. BEFORE PREGNANCY
 Education:
Related to Sexually Transmitted Diseases and
pregnancy prevention (usage of condoms and oral
contraceptives)
 Counseling:
Pregnant or lactating women on HIV and early
testing.

26. DURING PREGNANCY
 Antiretroviral drug regimens for treating pregnant
women: ART should be administered irrespective of
gestational age and is continued throughout
pregnancy, delivery and thereafter.

27.  All pregnant mothers infected with HIV should be
taking anti – HIV medicines by the second trimester
of pregnancy.
 Women diagnosed wit HIV later in the pregnancy
should start taking anti HIV medicines as soon as
possible.

28. DURING LABOR
 Avoid artificial rupture of membranes unless
medically indicated.
 Delivery by elective cesarean section at 38 weeks
before onset of labor and rupture of membranes
should be considered.
 Avoid procedures increasing risk of exposure of child
to maternal blood and secretions like use of scalp
electrodes.

29. AFTER DELIVERY

30. 1. Antiretroviral therapy:
 Symptomatic children should receive ART irrespective
of their immunologic stage.
 Asymptomatic children may be started on ART if they
have evidence of advanced or severe
Immunosuppression.

31.  The WHO now recommends initiation of ART for all
HIV infected children less than 2 years of age
irrespective of clinical symptoms and immunologic
stage.
 Zidovudine, lamivudine and nevirapine are used as
first line therapy.
 Alternative regimen includes stavudine, lamivudine
and nevirapine.

32. Regimens for infants born to HIV positive
mothers
 If mother received only zidovudine during antenatal
period:
For breastfeeding infants: Daily nevirapine from
birth until one week of age. 10mg/PO for infants
<2.5 kg and 15 mg /day for infants more than 2.5 kg.

33.  For non breastfeeding infants: Daily Zidovudine or
NVP from birth until 6 weeks of age. The dose is 4
mg / kg/PO per dose twice a day.

34. 2. Nutrition
 These children need nutritional rehabilitation. In
addition, micronutrients like zinc may be useful.

35. BREASTFEEDING:
 The risk of HIV infection via breastfeeding is highest
in the early months of breastfeeding. Exclusive
breastfeeding has been reported to carry a lower risk
of HIV transmission than mixed feeding.
 Mothers known to be HIV infected should only give
commercial infant formula milk as replacement feed
when specific conditions are met.

36.  In the absence of an antiretroviral (ARV)
intervention, and depending on the duration of
breastfeeding, approximately 10%-15% of infants
will become infected through breastmilk, and
breastfeeding can account for 40% of all mother-
to-child transmission (MTCT) of HIV.

37. WHO Guidelines on HIV and Infant Feeding
 In July 2010, the World Health Organization (WHO)
released revised guidelines on infant feeding by HIV-
infected mothers, generally targeted at low- and middle-
income settings.

38.  Mothers known to be HIV-infected should only give
commercial infant formula milk as a replacement
feed to their HIV-uninfected infants or infants who
are of unknown HIV status

39. 3. Immunization:
 The vaccines that are recommended in the national
schedule can be administered to HIV infected
children except that symptomatic HIV infected
children should not be given the oral polio and BCG
vaccines

40. NURSING MANAGEMENT
 Education concerning transmission and control of
HIV is essential for children with HIV infection.
 Basic tenets of standard precautions should be
presented.
 Provide support and encouragement to mother and
child.
 Encourage good nutrition and adequate rest.
 Regular assessment and monitoring

41. THANK YOU