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.

1. ACQUIRED IMMUNODEFICIENCY
SYNDROME(AIDS)
Shifa Muhammed Shaffi
Roll No. - 42
3rd year BSC Nursing

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