Review of HIV and Opportunistic Infections (OI) in Children
MCCC/HAKS Pediatric Staff Training October 2007 Slide 2 Review of
HIV What is HIV? Human Immunodeficiency Virus A virus is a germ or
microbe It enters the body and starts to grow bigger and bigger
Slide 3 Review of HIV (2) The Immune system is like a house that
protects a patient Slide 4 Review of HIV (3) HIV enters the body
and takes over the normal immune defenses Slide 5 Review of HIV (4)
When HIV takes over a persons immune system they can not defend
themselves against infections that normally do not cause bad
disease (Opportunistic Infections) Slide 6 Review of HIV (5) HIV
grows and the person starts to: Lose weight Cough Fevers Diarrhea
Difficulty breathing Skin Rashes Night sweats And many other
problems Slide 7 Review of HIV (6) When a child with HIV develops
certain infections or if their immune (CD4) cells drop below a
certain percentage, they have AIDS Acquired Immunodeficiency
Syndrome Can not be cured If they take medicine every day they can
become better and stay well for a long time Slide 8 Review of HIV
(7) ARV medicine rebuilds the immune system by fighting the HIV
Virus OI medicine helps prevent infection until the immune system
is strong again Slide 9 Case #1 6 mo female, mother HIV+, child not
tested Fever to 39 RR 70 Retractions Cough O2 saturation 85% XRay
Slide 10 Case #1 - PCP Differential Diagnosis Bacterial pneumonia
Viral pneumonia (CMV) Fungal pneumonia (cryptococcus, candida) TB
PCP Slide 11 Case #1 - PCP PCP Most common AIDS indicator disease
of children (33%) Peak incidence age 3-6 months CD4 count not
correlated with PCP infection Prophylaxis All children born to HIV+
women should be started on Trimethoprim/Sulfamethoxazole Treatment
Trimethoprim/Sulfamethoxazole 15-20mg/kg divided 3 times a day x 21
days (IV or PO) Oxygen, Prednisone 1mg/kg x bid for 5 days, 0.5
mg/kg bid for 5 days, 0.5mg qd for 5 days (give albendazole to
treat strongyloides infection prior to prednisone) Slide 12 Case #2
5 yo male with HIV+, not on ARV, CD4 count 100 (8%), presents with
3 weeks of Blurry vision Persistent Right red eye No pain in eyes
Fatigue Weight Loss Slide 13 Case #2 - CMV Retinitis Approximately
50% of AIDS patients will have some form of ocular involvement
during the course of their disease. Remain highly suspicious of any
such patient complaining of a vision change. They may be harboring
CMV retinitis, Toxoplasmosis or even candidiasis to name but a few.
A fundus exam followed by a referral is strongly recommended. Slide
14 Case # 2 - CMV More likely to present with low CD4 count (<
100) CMV/HIV coinfection worse prognosis Often no symptoms in young
children, older children complain of blurry vision,floaters Can
affect lungs, liver, Gastrointestinal tract Treatment: Ganciclovir
5mg/kg/dose IV twice a day for 21 days OR Intraocular Ganciclovir
injections Slide 15 Case #3 1 year old female, mother HIV+, child
not yet tested presents with Fever Poor feeding Irritability Mouth
& tongue ulcers Slide 16 Case #3 - Herpes Slide 17 HIV+
children can have recurrent ulcers in mouth and tongue With severe
disease can affect All skin Brain Esophagus Intestinal tract
Treatment intravenous acyclovir (5-10 mg/kg/dose three times daily)
or oral acyclovir (20 mg/kg/dose three times daily) for 7--14 days
Slide 18 Case # 4 7 yo male, HIV+, not on ARV, CD 4 count 50
presents with Weight loss Difficulty swallowing Sore throat Slide
19 Case # 4 - Candida Slide 20 Most likely in low CD4 count ( Case
# 5-6 8 yo male, HIV+, on ARV for 3 years, now CD4 decreasing (150)
and viral load increasing (> 150,000) presents with Fever Night
Sweats Cough Lymphadenopathy Weight loss Abdominal pain Slide 22
Case #5-6 TB Diagnosed with miliary TB, treated for 9 months
according to national protocol Slide 23 Case #5-6 TB Cough improves
but continues to have: Fevers Night sweats Weight loss Lethargy
Abdominal distension Slide 24 Case #5-6 TB /MAC Slide 25 Slide 26
Mycobacterium Avium Complex Treatment Change ARV to second line
since is failing first line Treat MAC drugs: clarithromycin or
azithromycin plus ethambutol (AI). Clarithromycin 7.5--15.0 mg/kg
body weight orally twice daily (maximum dose: 500 mg twice daily)
Or Azithromycin 10--12 mg/kg orally once daily (maximum dose: 500
mg daily) Plus Ethambutol is adminstered at a dose of 15--25 mg/kg
and is adminstered in single oral dose (maximum dose: 1.0 g) Slide
27 Review of HIV transmission When a person has contact with the:
Blood BloodSemen Vaginal secretions Breast milk Of a person who is
infected with HIV Slide 28 SEX Slide 29 Needle sticks Slide 30
Sharing needles with other people - drug users - people who reuse
needles over and over on many people Accidentally sticking yourself
with a needle that someone else used Slide 31 Wounds/cuts If
someone has a cut and you have a cut and their blood touches your
cut Slide 32 Pregnant women with HIV can give HIV to their baby
During Pregnancy During Labor & Delivery Breastfeeding Slide 33
Blood transfusion Slide 34 Ways you can not get HIV Slide 35
Shaking Hands Slide 36 Hugging Slide 37 Coughing Slide 38 Kissing
Slide 39 Eating or Drinking together Slide 40 Mesquitoes/ Insects/
Animals Slide 41 Sitting next to someone with HIV Slide 42 Living
with someone with HIV Slide 43 Conclusion The best way to prevent
HIV infection in children PMTCT Safe blood transfusions Safer
sexual practices The best way to keep a child with HIV healthy is
to MAKE THE DIAGNOSIS!!! Test all suspicious cases! Ensure
treatment and adherence with ARV Identify and treat Opportunistic
Infections Slide 44 THANK YOU!
