Multi- disciplinary approach in Paediatric HIV

DR Priyantha J PereraDepartment of Paediatrics

Faculty of Medicine, Ragama

∗ Nearly 1500 new Paediatric infections occur daily ∗ 71 cases up to now in SL∗ More than 90% of this is from the developing world

and most due to MTCT ∗ HIV-infected infants frequently present with clinical

symptoms in the first year of life∗ Without ART one-third of infected infants are dead by

one year and about half dead by 2 years

Current situation

∗ With ART, HIV-infected infants and children now survive to adolescence and adulthood

∗ Are we ready to face the challenges involved in providing a holistic care to these children.

Change in the trend

∗ Venepuncture hurts, plan your investigations and minimize the number of pricks

∗ Neonates have a limited blood volume – take only minimal volume required and avoid repeating investigations

Diagnosing Paediatric HIV

∗ If ART is started before their immune system is badly affected, CD4 levels recover quickly.

∗ Children with lower the viral load by one year of age, tend to have lower viral load when they are 8-20 years old.

Treatment of Paediatric HIV

∗ Compliance is a major issue ∗ Small children cannot swallow tablets and capsules∗ Children hate medicine – ARTs usually don’t taste nice∗ Medicines often go OS???????∗ fixed-dose combination drugs not available for

children∗ Dose is calculated according to body weight- so

increase the dose as they grow

Issues Related to Treatment of Paediatric HIV

∗ Apart from difficulties involved in diagnosing and initiating ART, managing Paediatric HIV is different to managing an adult with HIV

∗ Why??????∗ Because children are different. They are not just a half

of an adult

Managing Paediatric HIV

∗ Their nutritional requirements different∗ They are growing∗ They are learning ∗ More vulnerable to infections ∗ Immunizations∗ They ask questions∗ Emotionally unstable

Why children are different?

∗ Breast milk the best food during first six months not recommended when mother is HIV positive

∗ Correct and safe preparation of formula milk is important

∗ There is a risk of overfeeding with formula milkk∗ Gastro-enteritis in these children is more likely and

more damaging in these children

Nutrition

∗ Asymptomatic children living with HIV need 10% more calories

∗ symptomatic Children and those who are recovering from infections, 20-30% more calories than other children

∗ All ARTs supress the appetite. ∗ Recurrent infections supress the appetite

Nutrition

∗ On the other hand with the risk of metabolic syndrome later type of diet need careful selection

∗ Decreased bone density observed in these children warrant diets with more calcium and vitamin D

Nutrition

∗ HIV-infected children grow considerably slower, and differences between infected and uninfected children increased with age.

∗ This is due to both limited intake and increase demand

∗ Growth needs close monitoring∗ Issues of growth charts

Growth

∗ Does HIV infection effect neurodevelopment of children

∗ Does ART effect neurodevelopment of children∗ Adverse socio-economic condition do effect ∗ Bringing children in a simulative environment is vital

for optimum neurodevelopment

Neuro-development

∗ BCG∗ Hepatitis B∗ Pentavalent∗ OPV∗ Live JE∗ MMR∗ Chicken pox∗ Pneumococcal

Immunization

∗ They will want to know what is wrong with them∗ Why should I take daily medicine when I am not ill∗ What are you going to tell∗ When are you going to tell∗ Who is going to tell

Disclosure

∗ Ideally brought up in a family environment∗ Adoption, how feasible?∗ Should they attend normal school

Issues related to schooling and adoption

∗ Managing a child with HIV is not merely making an early diagnosis and starting ART

∗ There are many special issues to specific to children∗ Need a multidisciplinary approach to acehive

optimum care

Summery