HIV/AIDS infection

1. NURSING CARE OF
HIV/AIDS CHILDREN
PRESENTED BY:-
Akanksha Chandra
ABPL10010214001

2. INTRODUCTION
 CHILDREN are innocent victims of HIV/AIDS.
HIV or human immunodeficiency virus leads
to AIDS i.e. acquired immunodeficiency
syndrome.
 It is fatal illness and a pandemic disease
with large number of infected children
throughout the world. It is generally
asymptomatic.
 No vaccine is available for its prevention.

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 adoloscents is
represented by a continuum of
immunologic and clinical classifications
ranging from no to severe immunologic
suppression and asymptomatic to severely
symptomatic.

4. ANATOMY
PHYSIOLOGY
RELATED TO HIV
INFECTION

5. IMMUNITY
ACQUIRED
IMMUNITY
PASSIVE
IMMUNITY
ACTIVE
IMMUNITY
INNATE
IMMUNITY
NATURAL ARTIFICIAL

6. IMMUNOGLOBULINS
 IgG : # major serum immunoglobulin
# only maternal immunoglobulin that is normally
transported across the placenta and provides natural
passive immunity in the newborn.
# neutralises the viruses, encourage phagocytosis.
 IgA : # main immunoglobulin in the colostrum, saliva
and tears.
 IgM : # earliest immunoglobulin to be synthesised by
the foetus (beginning by about 20 weeks of age).
# not transported across placenta
# its presence in foetus or newborn indicates
intrauterine infection & its detection is useful in the
diagnosis of congenital infections such as syphilis, HIV
rubella, toxoplasmosis.

7.  IgD : # accounts for 0.2% of serum antibodies.
# IgD & IgM occur on the surface of
unstimulated B lymphocytes and serves as
recognition receptors for antigens.
 IgE : # responsible for anaphylactic type of
hypersensitivity.
# protection against pathogens by mast cell
degranulation and release of inflammatory
mediators.

8. HISTORY OF HIV
 First indication was came in 1981 in NY & LA (USA),
of a sudden unexplained outbreak of two very rare
disease, Kaposi’s sarcoma & Pneumocystis carinii
pneumonia in young adults who were homosexuals or
addicted to injected narcotics.
 In 1983, Luc Montagnier from the Pasteur institute,
Paris, isolated a virus from west afican patient with
generalised lymphoadenopathy and called it LAV.
 In 1984 Robert Gallo from NIH, USA isolated a
retrovirus from AIDS patients and called it HUMAN T
CELL LYMPHOTROPHIC VIRUS-III
 In 1986 the international committee on virus
nomenclature decided on the name HUMAN
IMMUNODEFICIENCY VIRUS (HIV).

9. EPIDEMIOLOGY
 People living with HIV : 36.7 million
There were approximately 36.7 million people living with
HIV at the end of 2015.
 People on antiretroviral therapy : 17 million
Including 2 million people who started treatment in 2015.
 Mother-to-child transmission : 7 out of 10
7 out of 10 pregnant women living with HIV received
antiretroviral treatment.
 1.1 million people died of AIDS-related illnesses
worldwide in 2015
 77% : 77% [69–86%] of all pregnant women living with
HIV globally received medicines that prevent
transmission to their babies in 2015

11. ETIOLOGY
 Caused by HUMAN
IMMUNODEFICIENCY VIRUS.

12. MORPHOLOGY OF HIV
 Spherical, enveloped virus
 Genome composed of 2 identical single stranded RNA
copies.
 Gene coding for structural proteins:
gag gene encodes for the core & shell of virus. Main core protein is p24.
env gene encodes the synthesis of the envelop glycoprotein gp160.
pol gene codes for the polymerase reverse transcriptase proteins p31, p51
and p66.
 HIV is highly vaiable virus. Based on molecular &
antigenic differences 2 types of HIV : HIV 1 & HIV 2.
 HIV1 is the original isolate and it has at least 10
subtypes ( A-J).
In India & China C subtype is common mainly spread through heterosexual
contact. And in USA b subtype is common transmitted via blood.

14.  Thermoliable and can be inactivated in 10
minutes at 60 degree C in seconds at 100
degree C.
 At room temperature (20-25°C) in dried
blood, may survive for upto 7 days.
 At atopsy, HIV has been isolated from
various tissues upto 16 days after death.
 For its surface decontamination standard
recommendation is a hypochlorite sol. At
the concentration of 0.5%.
 For treatment of contaminated medical
instruments. A 2% sol. Of glutaraldehyde is
useful.


16. TRANSMISSION

17. MODES OF TRANSMISSION
HIV is transmitted primarily via :-
 Unprotected sexual intercourse
 Contaminated blood transfusion
 Hypodermic needles
 Mother to child during pregnancy,
delivery and breastfeeding

18. VERTICAL TRANSMISSION
 A vertically transmitted infection ( or
mother to child transmission) is an
infection caused by bacteria, viruses,
or in rare cases, parasites transmitted
directly from the mother to an
embryo, foetus or baby during
pregnancy or child birth

19. PATHOGENESIS
 HIV virus enters in the blood of foetus through
the placenta of infected mother OR through
anyother mode of transmission
 Than 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

20.  Inside the cell,the virus genome uncoats and with
the help of reverse transcriptase, converts the
single RNA into double stranded DNA
 This DNA integrates into the infected cell genome
 This integration causes the formation of HIV virus
progeny with the help of host cell

21. CLINICAL
MANIFESTATIONS

22. CLINICAL MANIFESTATIONS
 At birth generally asymptomatic
 Clinical features appears in two
forms:-
 RAPID PROGRESSIVE(80%):-onset
is from 3-4 months of age
 SLOW PROGRESSIVE(20%):-onset
is from 8 years of age.

23. SOME GENERAL FEATURES
 Generalised lymphoadenopathy,
especially in axillary areas.
 Persistent or recurrent oral candidiasis
 Developmental delays
 Hepatomegaly, spleenomegaly
 Persistent diarrhoea
 Parotitis
 Unexplained anaemia,
Thrombocytopenia
 Unexplained cardiac and kidney disease
 Recurrent mild or serious bacterial
infections

24.  Opportunistic infection
Children with HIV infection & advanced or
severe immunosuppression are susceptible to
develop various opportunistic infections.
Important pathogens include Pneumocystis
jiroveci, cryptosporidium, Cryptococcus & CMV.
 Respiratory infection
• Pneumocystis pneumonia
• Recurrent bacterial infections
Common pathogens : streptococcus pneumonia
haemophilus influenza
staphylococcus aureus
pseudomonas aeruginosa

26. • Tuberculosis
Coexistent TB & HIV infections accelerate the progression of
both the diseases.
HIV infected children with the active TB receive longer
duration of anti-TB therapy. A 9-12 months treatment is
preferred.
• Viral infections : RSV, influenza & parainfluenza
• Fungal infections : Pulmonary candidiasis
• LIP
In the absence of ARV therapy nearly 20% patients develop
LIP.
Causative organism : primary lung infection with HIV,
Epstein-Barr virus(EBV) or both.

27.  GI diseases
Microbes causing GI infections:
Protozoal infections are most severe.
Children with cryptosporidium infestation can
have severe diarrhoea can lead to hypovolemic
shock.
AIDS enteropathy
Chronic liver inflammations like hepatitis caused
by HCV, HBV, CMV, mycobacterium may lead to
liver failure & portal HTN.
Pancreatitis is uncommon in children.
Bacteria Virus Protozoa Fungi
Salmonella
Campylobacter
M. avium
CMV
HSV
Rotavirus
Giardia
Cryptosporidium
Microsporidia
Isospora
Candida

28.  Neurologic diseases
Progressive encephalopathy
Impaired brain growth resulting in acquired
microcephaly
Meningitis due to bacterial pathogens and fungi
such as Cryptococcus.
Toxoplasmosis
 Cardiovascular involvement
Cardiac abnormalities in HIV are common,
persistent and progressive.
Tachycardia and other clinical indicators of
CHF.

30.  Renal involvement
Nephropathy
Nephrotic syndrome
Azotemia
Polyuria
Oligouria
Hematuria
Preschool
children
School
children
Adults
Polyuria 1 L/24h 2 L/24h 3 L/24h
Oligouria 1 mL/kg/h 0.5 mL/kg/h 400 mL daily

31. CLINICAL STAGING
ACCORDING TO WHO, there is
a clinical staging for HIV
infection and related
diseases in children.
STAGE 1
•Asymptomatic PAPULAR PRURITIC ERUPTIONS
•Persistent generalised
lymphoadenopathy
STAGE 2
•Papular pruritic eruptions
•Fungal nail infection

32. • Angular cheilitis
• Lineal gingival erythema
• Recurrent oral ulceration
• Recurrent chronic URTI

33. GINGIVAL ERYTHEMA
ORAL ULCERATION

34.  STAGE 3
• Unexplained moderate malnutrition
• Unexplained persistent diarrhea (14 days or more)
• Unexplained persistent fever ( above 37.5°C
intermittent or constant, for longer than 1
month).
• Persistent oral candidiasis (after 6-8 weeks of life)
• Oral hairy leukoplakia
• Acute necrotizing ulcerative periodontitis
• Lymph node tuberculosis
• Pulmonary tuberculosis
• Severe recurrent bacterial pneumonia
• Symptomatic lymphoid interstitial pneumonitis
• Chronic HIV associated lung disease including
bronchiectasis.

35. ORAL CANDIDIASIS
ORAL HAIRY LEUKOPLAKIA

36. Necrotizing ulcerative
periodontitis

37.  STAGE 4
• Unexplained severe wasting, severe malnutrition
not responding to standard therapy.
• Pneumocystis pneumonia
• Recurrent severe bacterial infections
• Chronic herpes simplex infection
• Esophageal candidiasis
• Kaposi’s sarcoma
• CMV infections
• CNS toxoplasmosis (after 1 month of life)
• Extrapulmonary cryptococcosis
• Chronic cryptosporidiosis (with diarrhea)
• Hodgkin lymphoma

38. ORAL CANDIDIASIS
ESOPHAGEAL CANDIASIS

39. HERPES SIMPLEX VIRUS INFECTION

40. KAPOSI’S SARCOMA

42. COMPLICATIONS
There are numbers of complications in HIV/AIDS. And
these complications include :-
• Recurrent infections
• Opportunistic infecions
• Acute and chronic ENT infections (Hearing loss Tooth
and gum diseases)
• Tuberculosis
• Malabsorption and wasting, developmental delays
• Cardiomyopathy
• Nephropathy, Neuropathy
• Neutropenia, anemia, thrombocytopenia
• Psychological crisis

43. DIAGNOSTIC EVALUATION
 ELISA - all pregnant women should be tested
for HIV before delivery. Neonatal testing with
Enzyme Linked ImmunoSorbent Assay (ELISA)
is indication of the presence of circulating
maternal antibodies to HIV and is not an
indication of child’s infection status.
 PCR- Polymerase Chain Reaction assay is most
sensitive, specific and preferred method for
detecting HIV infection in a child younger
than 18 months.

44.  WESTERN BLOT TEST – after age of 18 months,
HIV antibody assay can be used for testing
because maternal antibodies shouldn’t be
present by this age. As with adults, a reactive
ELISA must be followed by a confirmatory
western blot test.
 CBC – additional laboratory studies important
to follow on the HIV-exposed infant include
CBC with differential to monitor for anemia
and neutropenia and lymphocyte subsets (CD4
+ counts).
 For a known infected child, CBC with
differential, platelet counts, serum
chemistries, serial CD4+counts and HIV PCR
should be done every 3-6 months. In addition
baseline ECG and chest x-ray should be done
and repeated yearly.

45. Mannual flow chart for
diagnostic evaluation
sequence

46. MANAGEMENT OF
HIV/AIDS

47. ARV THERAPY
 The WHO now recommends initiation of ART for
all HIV infected children less then 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.

48.  The national programme for management of HIV
infected children recommends a combination of
ZIDOVUDIN, LAMIVUDIN and NEVIRAPINE as the
first line therapy.
 NRTI – nucleoside reverse transcriptase inhibitor
 NNRTI – non-nucleoside reverse transcriptase
inhibitor
 PI – protease inhibitor

50. COTRIMOXAZOLE
PROPHYLAXIS
 Also recommended for HIV exposed
breastfeeding children of any age.
 Should be continued until HIV
infection can be excluded by HIV
antibody testing atleast 6 weeks
after complete cessation of
breastfeeding

51. NUTRITION FOR HIV PATIENT
The Basic Principles of Nutrition and HIV:
 The basic principles of healthy eating will also
serve you well if you are HIV-positive. These
principles include:
 Eating a diet high in vegetables, fruits, whole
grains, and legumes
 Choosing lean, low-fat sources of protein
 Limiting sweets, soft drinks, and foods with added
sugar
 Including proteins, carbohydrates, and a little good
fat in all meals and snacks

52. Here is more specific information to get you started with a healthier eating
plan.
 Consume 17 calories per pound of your body weight if you've been
maintaining your weight.
 Consume 20 calories per pound if you have an opportunistic infection.
 Consume 25 calories per pound if you are losing weight.
 Protein helps build muscles, organs, and a strong immune system. To get
enough of the right types of protein:
 Aim for 100-150 grams a day, if you are an HIV-positive man.
 Aim for 80-100 grams a day, if you are an HIV-positive woman.
 If you have kidney disease, don't get more than 15%-20% of your calories
from protein; too much can put stress on your kidneys.
 Choose extra-lean pork or beef, skinless chicken breast, fish, and low-fat
dairy products.
 To get extra protein, spread nut butter on fruit, vegetables, or toast; add
cheese to sauces, soups, potatoes, or steamed vegetables; add canned tuna
to salads

53. IMMUNIZATION OF HIV
POSITIVE CHILDREN
 Routine paediatric immunization
must be given to HIV infected
infants and children with some
modifications
 Oral polio vaccine and BCG should
be omitted with symptomatic HIV
 Hepatitis B, inactivated polio
vaccine and MMR can be
administered to them.

54. NURSING
MANAGEMENT

55. NURSING ASSESSMENT
 Review maternal records to identify infants who may
be at risk for HIV disease. Infected infants are not
easily identifiable by outward appearance.
 Review records of at-risk or known infected children
to determine nutritional status, growth and
development, frequency of serious bacterial
infections, presence or risk of opportunistic
infections, laboratory values and immunization
status.
 Assess growth, development, lymphnodes,
hepatomegaly, spleenomegaly and oropharynx for
presence of oral candidiasis and dental caries.

56.  Assess the family’s understanding of child”s
condition, care needs, prognosis and medical care
plan.
 Assess family’s coping mechanisms, comfort with
disclosure issues and long-term plans for care
including transition plans for the child to an adult
care programme.
 Assess health of primary caregiver and discuss
long-term care plans for respite and permanent
alternative caregivers as appropriate.
 Assess the child’s understandings and health status
and medications.
 In children with advanced or end-stage disease,
assess the level of pain and discomfort.

57.  Assess the child’s coping and response to the
frequent painful and invasive procedures
experienced as part of ongoing diagnosis and
management of disease.
 Assess for animal contact.
 Take through travel history to evaluate risk of
coinfections such as TB, malaria or other microbial
infections. Also evaluate potential travel plans,
particularly to developing countries.
In adoloscents, assess increased at risk behaviours
such as substance use, piercing or sexual activity. Also
determine method of birth control, as appropriate.

58. LIST OF NURSING DIAGNOSIS
 Risk of infection related to immunodeficiency,
neutropenia.
 Ineffective therapeutic regimen management
related to insufficient knowledge of HIV, non-
compliance and limited resources.
 Imbalanced nutrition – less than body requirement
related to malabsorption, anorexia or pain.
 Impaired oral mucous membrane related tp
candidiasis and herpes stomatitis.
 Diarrhoea related to enteric pathogen, disease
process and medications.
 Hyperthermia related to HIV and secondary
infections

59.  Delayed growth and development related to HIV CNS
infection
 Ineffective family coping related to parentral guilt
and nature of disease.
 Ineffective coping of child related to unresolved
issues around the disclosure, hospitalization and
losses.
 Pain related to advanced or end-stage HIV disease.
 Fear releted to frequent invasive procedures,
diagnosis, stagmatization.

60. Imbalanced nutrition: less than body
requirements
MAY BE RELATED TO
 Inability or altered ability to ingest, digest and/or
metabolize nutrients: nausea/vomiting,
hyperactive gag reflex, intestinal disturbances, GI
tract infections.
EVIDENCED BY
 Weight loss, decreased subcutaneous fat/muscle
mass
 Lack of interest in sucking milk or in eating food
 Sore, inflamed buccal cavity and abnormal lab test

62. GOAL
 Maintain weight or display weight gain towards
desired goal, be free of signs of malnutrition
and display improved energy levels.
INTERVENTIONS
 Assess patients ability to chew, taste and
swallow
 Auscultate bowel sounds
 Weigh as indicated
 Schedule medications between meals and limit
fluid intake with meals, unless fluid has
nutritional value

63.  Limit food that induce nausea and vomiting or are
poorly tolerated by patient because of mouth sores
or dysphagia. Avoid serving very hot liquids and
foods
 Teach the family to prepare high calorie nutritious
meals that are pleasing and acceptable to
children.
 Insert or maintain NG tube as indicated
 Administer medications as indicated.

64. RISK FOR SECONDARY INFECTION
RELATED TO
 Inadequate primary defences, broken skin,
traumatized tissue, stasis of body fluids
 Depression of immune system, chronic disease,
malnutrition, use of antimicrobial agents
DESIRED OUTCOMES
 Achieve timely healing of wounds/lesions
 Be afebrile and free of purulent drainage/secretions
and other signs of infectious diseases

65. INTERVENTIONS
 Wash hands before and after all care contacts.
Instruct patient and relatives to wash hands.
 Discuss extent and rationale for isolation
precautions and maintenance of personal hygiene
 Educate the caregiver or a patient about the
importance of more than 95% compliance with
prescribed HAART(highly active antiretroviral
therapy) regimen to maximise viral reduction, which
in turn, will maximize immune reconstitution.
 Monitor viral load and total WBCs. The absolute
neutrophil counts may drop significantly as an ADRs
of ARV drugs.

66.  Use aseptic techniques when performing invasive
procedures.
 Provide and teach the family good skin care – a
break in the skin is a source of secondary
infection.
 Teach the family the importance of same food
preparation including use of safe water to avoid
introducing pathogens through contaminated or
undercooked food.
 Monitor immunization status and advice families,
the need to complete all recommended childhood
immunizations. In general, live vaccines should be
used with caution in children with HIV infection.

67. a) MMR and varicella vaccines are recommended for
HIV-infected children who are not severly
immuno-compromised.
b) OPV should be avoided because there is an
alternative injectable inactivated polio vaccine
available.
c) Yellow fever vaccine should be avoided unless the
risk of exposure is extremely high; consultation
with an expert is recommended.
d) Yearly influenza vaccine and a 3-5 year
pneumococcal vaccine are also recommended in
addition to the standard childhood immunization
schedule.
e) An annual TB skin test should also be
administered.

68.  Educate the families on potential risks associated
with pet ownership. In particular, cats may
transmit Toxoplasmosis or bartonella infections;
birds may transmit Cryptcoccus neoformans or
M.avium; reptiles may cause salmonellosis. Good
handwashing with soap and water is
recommended after handling animals; contact
with animal feces should be avoided.
 Educate teens about the use and importance of
using comdoms to prevent spread of HIV and
protect them from getting STDs such as syphilis
or chlamydia.

69. IMPAIRED ORAL MUCOUS MEMBRANE

70. IMPAIRED ORAL MUCOUS
MEMBRANE
RELATED T0
 Immunological deficit and presence of lesion
causing pathogens, eg:-candida, herpes
 Dehydration, malnutrition
 Ineffective oral hygiene
EVIDENCED BY
 Open ulcerated lesions, vesicles
 Oral pain/discomfort
 Stomatitis, leukoplakia, gingivitis, carious
teeth

71. DESIRED OUTCOMES
 Display intact mucous membranes, which are pink,
moist, and free of inflammations/ulcerations
INTERVENTIONS
 Assess mucous membranes and document all oral
lesions. Note reports of pain, swelling, difficulty
with chewing and swallowing
 Provide oral care daily and after food intake, using
soft toothbrush, non abrasive tooth paste, non
alcohol mouthwash
 Rinse oral mucous lesions with saline and dilute
hydrogen peroxide or baking soda solutions

72.  Suggest the sugarless gum or candy
 Plan diet to avoid salty, spicy, abrasive, and
acidic foods or beverages.
 Obtain cultural specimens of lesions
 Administer medications as indicated, nystatin,
ketoconazole

73. RISK FOR FLUID VOLUME
DEFICIT
RISK FACTORS INCLUDE
 Excessive losses: diarrhoea, profuse sweating,
vomiting
 Hyper metabolic state, fever
 Restricted intake, nausea, anorexia, lethargy
DESIRED OUTCOMES
 Maintain hydration as evidenced by moist mucous
membrane, good skin turgor, stable vital signs,
individually adequate urinary output

74. INTERVENTIONS
 Monitor daily weight when diarrhoea is present.
 Maintain intake output and assess skin and
mucus membrane for turgor and dryness.
 Administer IV hydration as indicated.
 Note temperature elevation and duration of
febrile episode. Administer tepid sponge baths
as indicated
 Monitor oral intake and encourage fluids of
atleast 2500ml/day
 Administer medications as directed for the relief
of severe diarrhoea and enteric infections.

75. ALTERED GROWTH AND
DEVELOPMENT

76. ALTERED GROWTH AND
DEVELOPMENT
RELATED TO
 HIV infections and CNS involvement
EVIDENCED BY
 Stunned growth
 Low body weight
 Mental retardation
 Less BMI as per age
GOAL
 Obtain maximum growth and development

77. INTERVENTIONS
 Measure the growth and development of child
according to age
 Provide adequate nutrition for proper growth
 Ask the parents to involve the child in those
activities that will enhance his IQ
 Give the prescribed medications on time
 Plan a proper diet chart to increase the weight
of the child
 Ask for follow up care

78. ANXIETY & ACUTE PAIN
 Related to threat of death of child and change in
health/socioeconomic status and pain associated
with invasive procedures as evidenced by increased
tension, feelings of helpless/hopeless, crying,
restlessness.
INTERVENTIONS
 Assess for signs of pain in the child. In the infant or
non-verbal child, such signs include restlessness,
crying, withdrawn behavior and changes in vitals.
 Make sure that all painful and invasive procedures
are done in a location other than child’s bed in the
hospital.
 Encourage verbalization and interaction with family.

79.  Monitor central line if used for venous access.
Central line access may be less traumatic
overtime than repeated peripheral access
attempts. Some children with HIV will need long
term probably, life long IV therapies and blood
monitoring and central line greately eliminates
the pain and anxiety associated with these
procedures.
 Use diversional techniques such as bubble
blowing for destraction during painful
procedures. Children can also be taught other
relaxation techniques.
 Offer small rewards after painful procedures to
reduce anxiety. Such rewards should be give
regardless of how the child reacted.

80. PREVENTION
Preventive measures are best attempts to
control the global problems of HIV/AIDS.
Four basic approaches to control HIV/AIDS
include:
a) Prevention by health education to make
lifesaving choices and avoiding blood-borne HIV
infection
b) ARVs treatment with combination therapy or
postexposure prophylaxis.
c) Specific prophylaxis for HIV manifestations,
e.g. isoniazid for TB.
d) PHC approaches with integrated care in Mother
and Child Health and health education.

81. PREVENTION OF MTCT
 ART regimen for treating pregnant women
2 options are available:
• Daily AZT in antepartum period combination of single
dose of NVP at onset of labor and dose of AZT and
3TC during labor followed by combination of AZT and
3TC for 7 days in postpartum period.
• Triple ARV drugs starting as earlt as 14 weeks of
gestation until one week after all exposure to breast
milk has ended(AZT + 3TC + LPV or AZT + 3TC + ABC)
where ABC is abacavir, LPV lopinavir.

82.  Regimen for infants born to HIV positive mothers
 If mother received only AZT during antenatal period
For breastfeeding infants : Daily NVP from birth until
1 week after all exposure to breast milk has ended. The
dose of nevirapine is 10mg/day/oral for infants less
then 2.5 kg or 15mg/day/oral for infants more then
2.5kg.
For non-breastfeeding infants : daily AZT or NVP
from birth until 6 weeks of age. The dose of AZT is
4mg/kg per oral per dose twice a day.
 If mother received triple drug ART during pregnancy
and entire breastfeeding daily AZT or NVP frpm birth
until 6 weeks of age irrespective of feeding.

83.  Intrapartum interventions
Avoid artificial rupture od membranes
(ARMs) unless medically indicated.
Avoid procedures increasing risk of
exposure of child to maternal blood and
secretions like use of scalp electrodes.
 Breastfeeding
Exclusive breastfeeding has been reported
to carry a lower risk of HIV transmission
than mixed feeding.
Infected mothers should only give
commercial infant formula milk as a
replacement feed

84. PROGRAMMES
 HIV prevention in India
 The National AIDS Control Organisation (NACO) is the body responsible for
formulating policy and implementing programmes for the prevention and
control of the HIV epidemic in India.
 The current programme, NACP-IV (2012-2017), aims to reduce annual new
HIV infections by 50% through the provision of comprehensive HIV
treatment, education, care and support for the general population and
build on targeted interventions for key affected groups and those at high
risk of HIV transmission.45
 Targeted interventions for key affected groups
 A key component of the NACP-IV is the prevention of new HIV infections
by achieving 80% coverage of key affected groups with targeted
interventions (TIs).
 TIs are implemented on the premise that prevention of HIV transmission
from key affected groups such as sex workers to their male clients (for
example) will lower HIV transmission among their sexual partners - e.g.
women in the general population.

85. • Project Pehchan
Project Pehchan was launched in October 2010 in order
to tackle the HIV epidemic among MSM, transgender
people in India.
• Avahan
The Avahan project works to reduce HIV transmission
among sex workers, MSM and transgender people
through the provision of education as well as condom
promotion, sexually transmitted infection (STI)
management, behaviour change communication,
community mobilisation and advocacy.
. Avahan is internationally recognised as a cost-effective,
successful, targeted HIV prevention programme.

86.  Link Worker Scheme
The Link Worker Scheme, supported by the UNDP, is a
community-based outreach strategy working to address HIV
prevention, treatment, care and support of hard-to-reach groups in
rural India. Specifically, the scheme provides information
resources on HIV and STI prevention, condom promotion and
distribution, HTC and referral to treatment. Since the introduction
of HTC in 2003, there has been a ten-fold increase in those
identified as living with HIV in rural Chhattisgarh. The project
currently operates in 163 districts across 17 states.
 The Red Ribbon Express
Launched in 2007, the Red Ribbon Express is an HIV and AIDS
awareness campaign train run by Indian Railways.
By 2013, the train had visited 23 states reaching more than 10
million people with messages about HIV prevention in rural parts
of India. The train now also provides HIV testing and counselling
(HTC) services and treatment for sexually transmitted infections
(STIs)

87.  The Condom Social Marketing Programme
(CSMP)
 The Condom Social Marketing Programme
(CSMP) aims to promote safer sex by
improving the availability of condoms and by
utilising multimedia to encourage behaviour
change. To date, two mass media campaigns
have been launched in Hindi as well as other
regional languages. By 2014, the CSMP had
distributed over 560 million condoms across
15 states.

88. NACO programmes by MP
government
 IEC – Information Education &
Communication
 ICTC – Integrated Counselling &
Testing
 Red Ribbon Club
 Link Worker Scheme

89. 1)Which of the following are the high
risk subjects for acquiring HIV
infection?
a)professional sex workers
b)drug addicts
c)persons getting repeated blood
transfusions
d)all the above

90. 2)After the child’s parents has been told that
their child have HIV AIDS, the parents ask what
AIDS is. How would you respond to the parents
question.
a)it is the disorder of adrenal gland
b)it often occurs among patients who are
getting radiation therapy
c)it occur due to mycobacterium tuberculi
d)it is spectrum of conditions caused by
infection with HIV virus

91. 3)What is the thing that nurse do in order to
prevent the spread of infection?
a)health education regarding the use of
condoms
b)avoiding multiple sex partners
c)sterilization of needles and syringe for
injections or immunization
d)all the above

92. 4)Your 5 year old male child who is HIV positive has
just expired. How would you care for this
diseased patient?
a)bath the patient but it is no longer necessary to
use standard precautions.
b)place the patient in a negative pressure
isolated area of the morgue
c)double shroud the patient to prevent the
spread of infection
d)bath the patient using the same standard
precautions you used when he was alive.

93. CONCLUSION
WITH SELF EXPLAINING VIDEO

94. REFERNCES
 Pediatric nursing by parul dUtta; 3rd edition;
jaypee brother medical publishers pvt ltd; pg no
229-232.
 Wongs essential of paediatric nursing
8th edition by marilyn J. hocken berry, david
wilson
 Nilson paediatric nursing book; 4th edition; pg no
448-452
 Lippincott medical surgical book; 9th edition,
nursing practice.
 www.who.org
 OP Ghai edition 8th page number 229 to 237
 Anantnarayan of microbiology edition 2010 page
number 52-57 and 177- 179.

95. World AIDS Day – December 1