2. Introduction
• As per WHO according to Global HIV Programme people living with HIV an estimated
population is around 39 million at the end of 2022.
• 1.5 million are children (0 to 14yrs ) .
• Since 2010 , the number of people acquiring HIV has been reduced by 38% .
• It has been seen 58% rapid decline in new HIV infections among children due to stepped
up efforts to prevent mother to child transmission of HIV.
3. Etiology
It is caused by HIV 1 and HIV 2 virus belonging to Reterovirade family and lentivirus
genus , which includes cytopathic viruses causing diverse disease in several animal
species .
Mode of transmission
1. Vertical Transmission
2. Postpartum/Breast feeding
3. Blood products
4. Sexual :- during child abuse / adolescence age group
5. Unsafe needles
4. Pathophysiology:-
1. Selective tropism for CD4+ molecular receptors :- Uses gp120 envelope protein to bind
CD4+ T cell
2. Internalisation :- For entering into cell membrane it uses CCR(Chemokine coreceptor)
3. Uncoating & Viral DNA formation :-
After entering into T cell cytoplasm
Viral RNA converted to DNA by reverse transcriptase enzyme
ss DNA converted to form ds DNA by DNA polymerase enzyme
This viral DNA then undergoes several mutations
4.Viral Integration :-
Viral DNA in cytoplasm
Enters into nucleus of host T cell using enzyme integrase At this stage it is called as
Provirus
5. 5.Viral Replication:- HIV provirus transcripts for Viral RNA , using tat gene Viral particle
multiplies
6.Latent period and Immune attack:- May remain inactive in infected T-cell for long time
period and immune system get activated and try to eliminate virus
7.CD4+ T cell destruction:- virus particle inside T cell forms buds it get detaches from host
cell and causes cell damage.
8. Viral dissemination
9.Impact if HIV infection on other immune cells
6. Case Definition: HIV Infection in Adults and children 18 months or older:
Positive HIV antibody testing (rapid or laboratory-based enzyme immunoassay)
confirmed by a second HIV antibody test (rapid or laboratory-based enzyme
immunoassay) relying on different antigens or of different operating
characteristics. and /or; Positive virological test for HIV or its components (HIV-
RNA or HIV- DNA or ultrasensitive HIV p24 antigen) confirmed by a second
virological test obtained from a separate determination.
Case Definition:-Children younger than 18 months: Positive virological test
for HIV or its components (HIV-RNA or HIV- DNA or ultrasensitive HIV p24
antigen) confirmed by a second virological test obtained from a separate
determination taken more than four weeks after birth. Note: Positive antibody
testing is not recommended for definitive or confirmatory diagnosis of HIV
infection in children until 18 months of age.
8. FOR CLINICALLY SYMPTOMATIC INDIVIDUALS
1) A patient who is clinically symptomatic and suspected to have hiv infection is referred to ICTC
for confirmation of the diagnosis.
2)In this case the blood sample is tested twice using kits with either different antigens or
principles.
3)The patient is declared hiv negative if the first test is negative
4)In case the first test is positive then a second assay is done.
5)In cases of indeterminate results testing is repeated at 14-28 days with new sample.
10. For clinically asymptomatic individuals
1) Confirmation of HIV diagnosis in asymptomatic patients is done at ICTC using three different rapid test of
three
different antigens.
2)The individual is considered hiv negative if first test is negative and positive when all three tests shows
positive result
3)For intdeterminate results testing should be performed 14 -28 days later as shown.
4) All HIV testing should follow five essential C’S – Consent, Confidentiality , Counselling , Correct test results
and immediate correction to services for hiv prevention.
15. FIRST TESTING WHILE CHILD IS ON AR
PROPHYLAXIS
AT 6 WEEKS
HIV DNA PCR
HIV DNA PCR+
START ART AND
ADD SYP
SEPTRAN TILL 5
YEARS
HIV DNA PCR-
FOLLOW UP AT 6
MONTHS WITH
PCR TESTING
IF POSITIVE IF NEGATIVE
DO ELISA
TESTING AT 18
MONTHS
POSITIVE
START ART
NEGATIVE
DO PREVENTIVE
MEASURES
16.
17. BASELINE INVESTIGATIONS
• HEMOGRAM/CBC
• URINE FOR ROUTINE AND MICROSCOPIC EXAMINATION
• FASTING BLOOD SUGAR
• BLOOD UREA,SERUM CREATININE
• SERUM BILIRUBIN, ALT (SGPT)
• VDRL CD4 COUNT
• X-RAY CHEST PA VIEW
• SYMPTOMS AND SIGNS DIRECTED INVESTIGATIONS FOR RULING OUT OI’S.
• COMPLETE LFT
• LIPID PROFILE
• USG A+P
• RK-39 STRIP FOR LEISHMANIA IN CASE TRAVELLING TO ENDEMIC AREAS
• CBNAAT SPUTUM
• STOOL R/M AND CULTURE
