PREPARED BY:NISHA DULAL3RD YR BSC(N)

WHAT IS

H.I.V????

“Human Immunodeficiency

Virus”

H = Infects only Human beingsI = Immunodeficiency virus weakens the immune system and increases the risk of infectionV = Virus that attacks the body

WHAT IS AIDS?????

“Acquired Immune Deficiency Syndrome”

A = Acquired, not inheritedI = Weakens the Immune systemD = Creates a Deficiency of CD4+ cells in the immune systemS = Syndrome, or a group of illnesses taking place at the same time

DEFINITION

H.I.V (Human Immunodeficiency

Virus) is a unique type of virus (i.e. a

retrovirus) that invades the T- helper

cells (CD4 cells) in the body of the host

(defense mechanism of a person).

AIDS:acquired immunodeficiency

syndrome is a disease of the human

immune system caused by infection

with human immunodeficiency virus.In

children it is acquired perinatally or by

vertical –maternal-infant trasmission.

INCIDENCEAccording to WHO 2.3 million children below 15 years are

affected i.e 7.7% of the world population Globally 91% from vertical trasmission 5% from nosochrombial trasmission 4% from sexual abuse

CAUSES HIV virus From mother to featus i.e during pregnancy,labor

and delivery and breast feeding Blood trasfusion Sexual trasmission

RISK FACTOR Advanced maternal disease High maternal viral load Prolonged rupture of membranes Vaginal bleeding During breast feeding

EPIDEMIOLOGICAL FEATURES

AGENT FACTORS:

“Human Immunodeficiency virus”

There are two types of HIV.1. HIV-12. HIV-2

HIV-1 HIV-2

HIV-1 is more common worldwide.

HIV-1 is easily transmitted.

HIV-1 is pathogenic in nature

Duration of HIV-1 infection is quite long.

HIV-1 is commonly seen in India.

HIV-2 is found in West Africa, Mozambique, and Angola.

HIV-2 is less easily transmitted.

HIV-2 is less pathogenic.

Duration of HIV-2 infection is shorter .

HIV-2 is relatively rare and has not been reported from India.

SOURCE OF INFECTIONGreater concentration:• Blood• Semen• CSP

Lesser concentration:• Tears• Saliva• Urine• Breast-milk• Cervical and vaginal secretions

HOST FACTOR

S:

AGE

•Most cases in between 20-49 years.

•Rarely seen in childrens under 15 yrs.

SEX

•Seen in both males & females.

•Mostly in homosexual and bisexual mens.

HIGH RISK

•Male homosexuals & heterosexual partners.

•IV drug abusers, transfusion if infected blood

IMMUNOLOGY

•HIV virus infects and destroys T-helper cells.

•It results in reduced cellular immunity.

TIMING OF HIV TRASMISSION

• INTRAUTERINE

• INTRAPRATUM

• POSTPRATUM

PATHOPHYSIOLOGY

Viral DNA is transcribed into mRNA

Integrase inserts viral DNA into Host DNA

RNA transcribes DNA by enzyme Reverse Transcriptase

RNA enters the human cell

HIV virus binds to CD4 receptors on surface of T cells.

Due to etiological factors

PATHOPHYSIOLOGY (CONTINUE..)

Destruction of T- helper cells and immune response declines causing S/S.

Host cell is killed as viruses are released and budding process starts.

Polyprotein converts into genome n becomes permanent part of cell’s genetic structure.

mRNA is translated into protein – polyprotein

INCUBATION PERIODupto 6 years or more

CLINICAL FEATURESWHO clinical staging system for HIV

infection and related disease in children:

1. Asymptomatic stage(stage 1)2. Symptomatic stage(stage 2)3. AIDS(stage 3)

STAGE 1- ASYMPTOMATIC INFECTION

o Asmptomatico Persistant generalized lyphadectomy

SYMPTOMATIC STAGEo Unexplained chronic diarrhoeao Severe persistant or candidiasis outside the

neonatal peroido Weight loss or failure to thriveo Persistant fevero Recurrent severe bacterial infection

STAGE 3- AIDS Aids defining opportunistic infections Severe failure to thrive Progressive encephalopathy Malignancy Recurrent septicemia or meningitis

OPPURTUNIS

TIC ORGANISMS

IF CD4<500

Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma

HERPES SIMPLEX

HERPES ZOSTER

LEUKOPLAKIA

KAPOSI’S SARCOMA

IF CD4< 200

Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma

IF CD4 <50

Disseminated mycobacterium avium complex

(MAC) infection

Histoplasmosis

CMV retinitis

CNS lymphoma

Progressive multifocal leukoencephalopathy

HIV dementia

DIAGNOSIS CLINICAL:

The WHO clinical case defines pediatric

AIDS if the existence of at least two major

signs associated with at least one minor

sign in the absence of other known cases

of immunosupression such as cancer or

severe malnutrition or other recognized

etiologies.

•Weight loss (10% of body wt)•Chronic diarrhoea•Prolonged fever or intermittent fever for over a month

MAJOR SIGNS

•Persistent cough over a month•Generalized dermatitis•Recurrent herpes zoster•Oropharyngeal candidiasis•Generalised lymphadenopathy

MINOR

SIGNS

OTHER SIGNS AND SYMPTOMS Persistant thrush

Lymphadenopathy

Hepatosplenomegaly

Chronic diarrhoea

Parotid gland enlargement

Leukopenia

Hepatitis

Cardiomyopathy

Nephopathy

SCREENING TESTS

BLOOD DETECTION TEST

Enzyme Linked Immunosorbent Assay (ELISA)

• Screening test for HIV• Sensitivity > 99.9%

Western blot

• Confirmatory test• Specificity > 99.9% (when combined with ELISA)

Absolute CD4 lymphocyte count

• Predictor of HIV progression• Risk of opportunistic infections and AIDS when

<200

HIV viral load tests

• Best test for diagnosis of acute HIV infection• Correlates with disease progression and response

to HAART

TREATMENT

MANAGEMENT

There is no curative treatment of hiv aids.no vaccine are available for prevention.so children should be protected from contacting the hiv infection

Immunization can be given to hiv infected infant and children i.e are hepatitis b,polio vaccine,mmr,bcg etc

Plenty of fluid should be provided Nutriotional food shold be given

Medication like antidiarrhoeal,antipyretics,analgesics,antitursive drug shold be given.

Antiretroviral drugs is given when the child have signs of immunodepression or hiv associated symptomsi.e are didanosine,zalcilabine,staudine etc.these are used for prolongation of life.

Other drugs like prolease inhibitors,non nucleoside reverse transcriptase inhibitors is also given with antiretroviral combination therapy

PREVENTION Antiretroviral treatment with combination

therapy or post exposure prophylaxis to prevent hiv in children.

Vertical trasmission can be prevented by zidovudine prophylaxis to the infected pregant women antd to infant till 6 weeks of life.

Health education shold be given to people to avoidins blood brone hiv trasmission.

Provide specific prophylaxis for hiv manifestations.

Parent to child trasmission can be prevented by avoiding indiscrimate sexaul practices of adults.

Heticulous screening of blood and blood products should be done before blood trasfusion.

Sterilized syringe and needle should be used for immunization.

Aseptic techniques should be used during delivery.

Promoting community awareness of spread of hiv infection for unsafe practices.

NURSING DIAGNOSIS Risk for infections related to

immuodefiency rate. Alterd nutrition related to anorexia,pain in

abdomen. Diarrhoea and dehydration related to

enteric pathogens and infection. Alterd pain related to advanced hiv

diseases. Fear and anxiety related to diagnostic and

treatment procedures. Knowledge deficit regarding trasmission

of hiv infection.

ANY DOUBTS??