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PAEDIATRICS HIV

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  1. 1. NUR HANISAH BINTI ZAINOREN PAEDIATRIC
  2. 2. CONTENT Introduction Clinical manifestations Diagnosis Management
  3. 3. INTRODUCTION
  4. 4. HIV is the virus which attacks the T-cells in the immune system AIDS is the syndrome which appears in advanced stages of HIV infection HIV is a virus AIDS is a medical condition
  5. 5. CLINICAL MANIFESTATIONS
  6. 6. Vary widely among infants, childrens and adolescents In most infants, physical examination at birth is normal Initial signs and symptoms may be subtle and non- specific (eg: failure to thrive, lymphadenopathy, hepatosplenomegaly, chronic/recurrent diarrhea, interstitial pneumonia, oral thrush)
  7. 7. In United States and Europe: systemic and pulmonary findings are common In Africa: chronic diarrhea, wasting, malnutrition are common
  8. 8. Symptoms commonly found MORE in CHILDREN than adults are: Recurrent bacterial infection Chronic parotid swelling Lymphocytic interstitial pneumonitis Early onset neurologic deterioration
  9. 9. Paediatic HIV staged by two parameters Clinical status Degree of immunologic impairment
  10. 10. Clinical status (WHO Clinical Staging of HIV/AIDS with Confirmed Infection) Clinical stage 1 Clinical stage 2 Clinical stage 3 Clinical stage 4
  11. 11. Clinical status (WHO Clinical Staging of HIV/AIDS with Confirmed Infection) Clinical stage 1 Clinical stage 2 Clinical stage 3 Clinical stage 4 Asymptomatic Persistent generalized lymphadenopathy
  12. 12. Clinical status (WHO Clinical Staging of HIV/AIDS with Confirmed Infection) Clinical stage 1 Clinical stage 2 Clinical stage 3 Clinical stage 4 Unexplained persistent hepatosplenomegaly Papular pruritic eruptions Fungal nail infection Angular cheilitis Lineal gingival erythema Extensive wart virus infection Extensive molluscum contagiosum Recurrent oral ulceration Unexplained persistent parotid enlargement Herpes zoster Recurrent/chronic URTI (otitis media, otorrhea, sinusitis, tonsillitis)
  13. 13. Clinical status (WHO Clinical Staging of HIV/AIDS with Confirmed Infection) Clinical stage 1 Clinical stage 2 Clinical stage 3 Clinical stage 4 Unexplained moderate malnutrition or wasting not adequately responding to standard therapy Unexplained persistent diarrhea (14 days or more) Unexplained persistent fever Persistent oral candidiasis Oral hairy leukoplakia Acute necrotizing ulcerative gingivitis/periodontitis Lymph node TB Pulmonary TB Severe recurrent bacteria pneumonia Symptomatic lymphoid interstitial pneumonitis Chronic HIV-associated lung disease including bronchiectasis Unexplained anemia, neutropenia or chronic thrombocytopenia
  14. 14. Clinical status (WHO Clinical Staging of HIV/AIDS with Confirmed Infection) Clinical stage 1 Clinical stage 2 Clinical stage 3 Clinical stage 4 Unexplained severe wasting, stunting or severe malnutrition not responding to standard therapy Pneumocystic pneumonia Recurrent severe bacterial infections Chronic herpes simplex infection Esophageal candidiasis Extrapulmonary/disseminated TB Kaposi sarcoma CMV infection CNS toxoplasmosis Extrapulmonary cryptococcosis HIV encephalopathy Chronic cryptosprodiosis Chronic isosporiasis Cerebral or B cell non-Hodgkin lymphoma Progressive multifocal leukoencephalopathy Symptomatic HIV-associated nephropathy or HIV- associated cardiomyopathy
  15. 15. Degree of immunologic impairment (Severity of immmune suppression based on CD4 levels in children) Immune Status Age 5yr Not significant >35% >30% >25% >500 cells/mm3 Mild 30-35% 25-30% 20-25% 350-499 cells/mm3 Advanced 25-30% 20-25% 15-20% 200-349 cells/mm3 Severe