1. CHILDREN and HIV

2. Basic information:
75% of children living with HIV (CLHIV) present with symptoms in the first or second year of life (most often at the primary level clinic).
75% of children Infected and affected by HIV are severely malnourished.
Nutrition requirement for an asymptomatic CLHIV is an additional 10% of calories while in symptomatic phase they require 30% more.
>40% of HIV-infected children die before 2 years of age.
80% of infant deaths occur at home

3. Differences in HIV between adults and children
Immature immune systems - susceptible to infections (OIs).
 Carry maternally-acquired antibodies below 18 months. A PCR is required
 Normal CD4 counts are higher in young children than in adults.
 ARV drugs are handled differently in children – affecting dosage needed. Dose adjusted to weight.
 Counseling children for disclosure of their HIV status, to discuss ART, and to support adherence to ART requires special skills in communication.
 Need to simplify language

4. Routes of transmission
In order of occurrence as:
The most common route is Mother to Child Transmission of HIV during pregnancy (intra partum), delivery (peri partum) and during Breast Feeding (Post Partum).
Repeated Blood transfusions of contaminated blood in the treatment of Thalessemia, Hemophilia and Leukemia.
Sexual Route: through sexual abuse and early sexual exposure by unprotected sex.

5. Mother to Child Transmission of HIV

6. Types of Infant Feeding Practice
Exclusive Beast feeding
Replacement Feeding
Mixed Feeding

7. DIAGNOSIS OF PEDIATRIC HIV

8. Testing algorithm
Infants: presence of passively transferred maternal antibody up to 18 months
HIV Exposed
child
9 to 18 months
6 wks to 9 months
>18 months
6 wks to 9 months: DNA PCR. If negative at 6 wks, repeat at 4 months, if negative, baby is not infected. If postive, repeat DNA PCR as soon a s possible to confirm positivity.
9 months to 18 months: Do antibody test first. If negative, baby is uninfected. If positive, DNA PCR needs to done, as antibody can still be maternal antibodies at this age.
(Trainer will refer to the flow chart handout.)
HIV Antibody
DNA PCR
HIV Antibody
DNA PCR
If breastfeeding: repeat age-appropriate tests at least 6-8 weeks after stopping breastfeeding.

9. When virological tests are NOT available
Presumptive diagnosis of severe HIV disease in infants and children aged <18 months
When virological tests are NOT available
HIV Antibody positive
AND
AIDS indicator condition (e.g. Pneumocystis pneumonia, cryptococcal meningitis, HIV wasting, Kaposi sarcoma, extrapulmonary tuberculosis.) OR
HIV Antibody positive
AND
Infant is symptomatic with 2 or more of the following: - oral thrush
- severe pneumonia
- severe sepsis
When virological testing is NOT available for diagnosis in infants less than 18 months of age……a presumptive diagnosis of severe HIV infection can be made, based on which ART may be initiated. By definition, presumptive means an HIV diagnosis that is not definitively confirmed.
Supportive evidence:
- recent HIV-related maternal death or advanced maternal HIV dis. - %CD4+ <20.

10. ART

11. Questions when starting ART
WHO?
WHAT?
WHEN?
HOW?

12. Influencing factors: Child: Depend on adults Taste, smell, color
Emotional Factors
Frequency and other medicines
Experiment - ? If I do not take
Caregiver:
Understanding of Hiv
Misconceptions of ART
Their own health, daily routine and closeness with the child