HIV/AID awareness by Dr PZ Buthelezi-Mlambo

HIV AND AIDS chronic disease cannot be cured but well manage and controlled its not life death sentence. Therefore having HIV does not mean you have AIDS, even without treatment it takes long time for HIV to progress to AIDS, usually 10-12yrs. If HIV is diagnosed before it becomes AIDS, medicine can slow or stop the damage to the immune system Difference: viral infection reduces insidious and progressive loss of immune function that eventually results in opportunistic infection and malignancies that used in define AIDS Prevalence: In 2008, HIV/AIDS was most prevalent in the South African provinces of KwaZulu-Natal (15.8% HIV-positive), Mpumalanga (15.4% HIV-positive), Free State (12.6% HIV-positive), and North West (11.3% HIV-positive), while only 3.8% of the population was HIV-positive in Western Cape DEFINITION: Human Immune Deficiency Virus (HIV) that attack the Immune system, the body’s natural defense system ie. CD4 count without a strong immune system the body has trouble fighting off disease AIDS: the last stage of HIV infection low number of CD4 cells and get infections or cancer that rarely occur in healthy people

Routes of transmission Unprotected sexual intercourse Blood transfusion Sharing of needle or injection or blades Organ transplantation Mother to child contaminated blood products   #note it is not transmitted by hugging, eating on same plate toilet seat, coughing and sneezing

WHO- STAGING STAGE 1:Asymptomatic Persistent generalized lymphadenopathy STAGE 2:Moderate weight loss more than 10% Recurrent respiratory infections (sinusitis, tonsillitis, otitis media) Herpes Zooster Recurrent oral ulcers Popular pruritic eruptions Seborrhea dermatitis Fungal nail infections STAGE 3:Severe weight loss more than10% Chronic diarrhea more than 1 month Persistent fever more than a month Persistent oral conditions Oral hairy Pulmonary tuberculosis Severe bacterial infections Unexplained anemia STAGE 4:HIV wasting syndrome PCP Recurrent several bacterial Pneumonia Chronic herpes simpler infection Oesophageal candidates Extra pulmonary tuberculosis HIV Encephalopathy Stereptocal Meningitis Lymphoma Infusive cervical cancer Nephropathy or Cardiomyopathy  

Signs and symptoms Head: Fungal skin infection meningitis encephalopathy, stroke eyes: herpes zoot results in blindness Ears: discharging and lymphodes Mouth gingivitis Chest: pneumonia, TB, Abd: chronic diarrhoea vomiting, cervical cancer, chronic STI/Ulcers Legs: peripheral neuris Skin: dermtaphy, dermatis Blood:

Diagnosis Only diagnosed by doctor by taking sample/bloods   Only diagnosed by doctor by taking sample/bloods Pre- and post-test counselling Purpose of HIV testing is simply identify infected individuals, but also to educate both zero positive and zero negative people about prevention and limiting transmission of the virus Before taking blood consent form must be signed Bloods Elisa PCR CDD4 count Viral load

HIV MANAGEMENT Children should be tested for HIV infection HIV TESTING IN CHILDEN Children should be tested for HIV infection All HIV exposed infants Children do with TB or have hoof TB treatment Father or sibling with HIV infection death/ death of mother, father, sibling Mothers HIV status is unknown and her whereabouts are unknown Child breast fed or well nursed by women of unknown or positive status Children and clinical feature of HIV infection Children who have experienced or breast risk of sexual assault Test:HIV antibody detective test(eg hiv elisa)-  cannot distinguish between mother and body antibioticsmmmmm HIV antibodies are transferred via the placenta to the baby during pregnancy so that all vertically exposed babies will be born with HIV antibodies and will test positive on antibody detectives test. The antibodies will remain in the babies’ blood upto18 months ie HIV exposed. Then viral detection test such as HIV DNA(detect HIV gene humanly) PCR (detect 6 weeks is required) to establish the infection status of child. Therefore HIV exposed but uninfected child will test PCR negative and HIV exposed infected child will test PCR positive Viral load 10 000 copies/ml (4) is regarded as confirmation of HIV infection if PCR is positive

Hiv/Aids management Prevention is better than cure- zero infection new generation PMTCT: All pregnant women look early before 14 weeks gestation All first antenatal books must be seen on same day Booking bloods include RPR, RH, HB, HIV Folic acid, Vit C, calcium, should be given at first visit   If women test negative at 1st anetal visit- retest 12 weeks after 1st HIV test and 32 weeks of gestation in labour,6 weeks post every 3 months while breast feeding thereafter annually If women test positive at first anental visitall women regardless of CD4 cell count will be initialed or fixed dose drugs(FTC+TOF, EFV) on same day they are diagnosed HIV positive Blood creatine and CD4 are done the same day the review on 7 days CD4 350 cell/mm CD4 count 350 continue with ARV for duration of pregnancy and for 1 week after gestation of breast feeding then stop ARV  If already on ARV and pregnant- check CD4 count, VC, .if virally suppressed continue with the if not suppressed, asses adherence the change to Women diagnosed HIV positive during pregnancy intra Start NVP and TRUVIDA and 3 hrly AZT Start FDC as soon as possible if breast feeding 

Hiv/Aids management All HIV exposed infants: NVP syrup for 6 weeks irrespective of feeding BW> 250g 1,5ml daily at same time everyday Sw< 250g 1ml daily PCR test at 6 weeks for all HIV If breast fed, repeat PCR test in 6 weeks after of breast Exclusive breast feed is recommended feeding 18 months rapid HIV test done for all HIV expose   Criteria to start ARV All children 5yrs 3yrs(<10kg) 3yrs(10kg) If 3yrs and exposed NVP for 6 weeks or longer infant or ABC+ Failed regime( 2nd lie regme) ABC+3FC+EFV/NVP  AZT+3TC+ LPV/M

HIV EXPOSED INFANTS Done for 6 weeks 6 weeks must visit the doctos and clinics for immunization and PCR testing cotooooooooooooo …………….. / 4kg from 6 weeks MVT include Vitamin A IPT( prevent TB since HIV infected children have high risk of acquiring tubercolcese even HIV negative children 5yrs who are exposed to TB causes reduce the risk of TB by 95% Breast feeding can result to post natal transmission anytime during breastfed if child already PCR positive continue with it If PCR negative and continue with breast feed you must repeat HIV test after 6 week of stopped breast feed

Anti-retroviral therapy Clinical criteria: confirm HIV infection in children 1 year 1-5yrs symptoms stage 25 or CD4 25% Recruit 2admission to hospital for HIV complication Social criteria: 1 care hiver who is able to supervise and advertise medication Disclosure to another adult living in the same house in exchange so may assist with ARV   Doses of ARV in children depends on the weight gain(NVP dosage), if small dose are given or poor adherence will result inresistance or failure where child CD4 count does notrise, viral load becomes dectable Regimes 2nd line regime: used following treatment failure copies despite good AZT,SDI,ALII ABC.BTC, ALUU