aids and hiv in children. it is the topic in child health nursing. it include definition, etiology, types, signs and symptoms, pathophysiology, clinical stages, diagnosis and management of pediatric hiv or aids.
2. INTRODUCTION
A clinical entry characterized by profound loss of immune
function associated with a depletion of CD4 helper T
lymphocytes, was recognised between 1981 and 1985.
It was named as acute immunodeficiency syndrome (AIDS).
It was found that this syndrome is caused by infection with
human immunodeficiency virus (HIV).
3. DEFINITION
HIV AIDS is a spectrum of conditions caused by infection
with the human immunodeficiency virus.
Human immunodeficiency virus infection for infants, children
and adolescents is represented by a continuum of
immunologic and clinical classifications ranging from no to
severe immunologic suppression and symptomatic to
severely symptomatic.
4. INCIDENCE
Globally, their were 3.2 lakh children below 15 years of age who
died due to AIDS by 2002.
According to the Global report on AIDS epidemic in 2010, UNAIDS
in India the estimated number of HIV-infected children under 15
years was 4%. The report also stated that 80% of children born with
HIV infection die before the age 15 years.
5. ETIOLOGY
AIDS is caused by a retrovirus namely HIV or lymphadenopathy-
associated virus (LAV) or human T-lymphotropic virus type III
(HTLV - III).
The HIV is an enveloped virus, approximately 120 nm in diameter
and belongs to lentiviridae. subfamily of retroviridae.
Two serotype namely HIV1 and HIV2 have been recognised.
HIV is more pathogenic. HIV is liable virus inactivated by heat
(56⁰C for 30 min), ether acetone, 20% ethanol, 0.2 % Sodium
hypochlorite and 1% glutaraldehyde.
6. MODE OF TRANSMISSION
Transmission of HIV occurs by two ways; horizontal
transmission & vertical transmission.
The mother to child transmission is most significant
mode of transmission of HIV infection in children below
15 years.
It account for 90% cases of infection.
7. This vertical transmission from mother to child occur in utero(30-
35% cases) during delivery(60-65%) and through breast feeding(1-
3%)
Horizontal transmission accounts for 10-15% HIV case in children.
It includes transmission by sexual intercourse needle stick injury,
contaminated blood & blood products.
MODE OF TRANSMISSION
8. PATHOPHYSIOLOGY
HIV virus enters in the blood of foetus through the placenta of infected
mother or through any other mode of transmission
Then the virus comes in contact with CD4 lymphocytes
It binds with CD4 antigen present on the T lymphocytes and B
lymphocytes
After binding the virus enters the cell
9. PATHOPHYSIOLOGY
Inside the cell, the virus genome uncoates and with the help of reverse
transcriptase, converts the single RNA into double strand DNA
This DNA integrates into the infected cell genome
This integration causes the formation of HIV virus progeny with the help of
host cell
10. CLINICAL FEATURES
MAJOR SIGNS
Weight loss or abnormally slow growth
Chronic diarrhoea for more than 1 month duration
Prolonged fever for more than 1 month duration
MINOR SIGNS
Generalised lymphadenopathy, especially in axillary areas
Developmental delays
Persistent or recurrent oropharyngeal candidiasis
Hepatomegaly, spleenomegaly
Repeated common infections
11. CLINICAL FEATURES
Persistent diarrhoea
Parotitis
Unexplained anaemia, thrombocytopenia
Unexplained cardiac and kidney disease
Opportunistic infection
Children with HIV infection and advanced or severe
immunosuppression are susceptible to develop various
opportunistic infection
12. CLINICAL STAGING OF HIV IN CHILDREN
STAGE – 1
Asymptomatic
Persistent generalised lymphadenopathy
STAGE – 2
Unexplained persistent hepatosplenomegaly
Pruritic popular eruption
Extensive warts virus infection
Extensive molluscum contagiosum
13. CLINICAL STAGING OF HIV IN CHILDREN
Recurrent oral ulceration
Fungal nail infection
Lineal gingival erythema(LGE)
Unexplained persistent purotial enlargement
Herpes zoster
Recurrent or chronic respiratory tract infection (otitis media
otorrhea, sinusitis and tonsillitis )
14. CLINICAL STAGING OF HIV IN CHILDREN
STAGE – 3
Unexplained moderate malnutrition not adequately responding to
standard therapy
Unexplained persistent diarrhoea (>14 days)
Unexplained persistent fever (>37.5°C intermittent or constant for
longer than 1 month)
Persistent oral candidiasis(After 1st 6-8 weeks of life)
Oral hairy leukopenia
Pulmonary TB
Lymph node TB
15. CLINICAL STAGING OF HIV IN CHILDREN
STAGE – 3
Severe recurrent bacterial pneumonia
Acute necrotizing ulcerative gingivitis/periodonditis
Symptomatic lymphoid interstitial pneumonitis(LIP)
Chronic HIV-associated lung disease, including bronchiectasis
Unexplained anaemia (<8g/d<) neutropenia(<1000/mm³) or
chronic thrombocytopenia (<50,000/mm³) for > 1 month
16. CLINICAL STAGING OF HIV IN CHILDREN
STAGE – 4
Chronic herpes simplex infection (oro labial cutaneous infection of
>1 month duration)
Extra pulmonary tuberculosis
Kaposi's sarcoma
Oesophageal candidiasis(or candidiasis of trachea, bronchi, or
lungs)
Central nervous system (CNS) toxoplasmosis(after one month of
life)
HIV encephalopathy
17. CLINICAL STAGING OF HIV IN CHILDREN
STAGE – 4
Cytomegalovirus (CMV) infection: retinitis or CMV infection affecting
another organ; with onset at age over 1 month
Extra pulmonary cryptococcosis(including meningitis)
Chronic ayptosporidiosis
Chronic isosporiasis
Disseminated non tuberculosis mycobacterium infection
Cerebral or B cell non-Hodgkin lymphoma
Progressive multifocal leukoencephalopathy(PMC)
Symptomatic HIV-associated nephropathy or HIV-associated
cardiomyopathy
18. DIAGNOSTIC EVALUATION
Infection is diagnosed by detection of HIV lgG
ELISA is used for screening & the western blot method is
used for confirmation
Polymerase chain reaction(PCR) can detect minute
quantities of the virus in an infant blood
Culture a sample of an infant’s blood and test for the
presence of HIV
19. MANAGMENT
The WHO now recommends initiation of Antiretroviral Therapy (ART) for
all HIV infected children less than 2 years age irrespective of clinical
symptoms and immunological state
Availability of ART has transformed HIV infection from a uniformly fatal
condition to a chronic infection, where children can lead a normal life.
The currently available therapy doesn’t eradicate the virus and cure the
child, it rather suppresses the virus replication for extended period of
time.
HAART is a combination of 2 NRTIs with a PI or a NNRTI.
The national programme for management of HIV infected childen
recommends a combination of ZIDOVUDIN, LAMIVUDIN, anD
NEVIRAPINE as the first line therapy.
20. MANAGEMENT
NRTI – Nucleoside Reverse Transcriptase Inhibitors
NNRTI – Non Nucleoside reverse transcriptase inhibitors
PI – Protease inhibitors
Along with antiretroviral therapy, pneumocystis pneumonia prophylaxis
should be given to infants in whom infection is detected on the base of
positive viral test
Use of IV lg in infected children who have 2 or more serious bacterial
infection within 1 year
Antifungal drugs such as nystatin, ketoconazole, fluconazole and
clotrimazole ma be give in cases of persistent or recurrent oral
candidiasis
21. Nursing care of children with AIDS differ from that of adults
The care givers should wear gloves while changing diapers & good
handwashing need to be practiced.
Barrier nursing should be practiced while providing care to these
children
These children should not be given any live vaccine although killed
vaccine can be given like salk killed polio vaccine instead of sabine oral
polio vaccine
Most of these children receive iv gamma globulin every 1 – 4 weeks to
provide immunity against some disease
Many of these children have lactose intolerance, so lactose free diet is
recommended for them.
NURSING MANAGEMENT
22. In children with oral lesion, a bland diet with colour liquid may help
increase the intake.
To meet the nutritional needs, these children should be given twice the
recommended daily requirement for their age, with increase amount of
proteins and carbohydrates.
Skin care is especially important since diarrhoea may be an ongoing
problem.
Perineal skin should be kept clear and dry, to prevent skin excoriation.
NURSING MANAGEMENT
23. PREVENTION OF VERTICAL
TRANSMISSION (Mother to child transmission)
Mother to child transmission of HIV can be reduced to 50% by
administering a regiment of zidovudine to the mother and also to the new-
born
Mother is given zidovudine 100mg, 5 times per day, orally from fourth
week of gestation till delivery
At the time of delivery 2mg/kg iv, zidovudine is given in the first hour of
labour followed by 1mg/kg every 6 hourly till 6 weeks of life
When zidovudine treatment is combined with elective caesarean delivery,
the transmission rate can be reduced up to 2%
24. Universal precaution must be taken while caring for the new-born or
child
If blood or blood products need to be administered to children they must
be taken from stringent donor
Sterile and disposable needle and syringes must be used while taking
blood sample or for administration of medication
Post exposure prophylaxis must be given
PREVENTION OF HORIZONTAL
TRANSMISSION