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PAEDIATRIC AIDS ¨ Acquired immunodeficiency Syndrome (AIDS) is caused by Human Immunodeficiency Virus type 1 and 2 ¨ World wide problem, more so in developing Countries. ¨ Ever since the report of the first pediatric case in 1983, there has been an alarming increase in the incidence of disease ¨ WHO estimate of about 5 to 10 million children expected to be infected by the end of year 2000AD worldwide.
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PAEDIATRIC AIDS HIV infection occurs by contact with infected cells in blood and body fluids. T The predominant cells infected are CD4+ T lymphocytes, depletion of which causes immunodeficiency.
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PAEDIATRIC AIDS ¨ EPIDEMIOLOGY
¨ Pediatric AIDS constitutes 2% of all HIV infected cases in developed countries as compared to 15-20% in developing countries ¨ In India, women and children constitute 50% of all HIV infected individuals ¨ The pediatric population at risk for HIV-1 infection are; Ø babies born to infected mothers,
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PAEDIATRIC AIDS ¨ Ø children given HIV-1 contaminated blood or blood products, Ø adolescents who acquire infection sexually or by use of intravenous drugs ¨ The rate of mother to child transmission (vertical) of HIV-1 evaluated epidemiolocally in several surveys, has varied from 13-42%, with 65% of newborns infected during last six weeks of pregnancy and at delivery. ,
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PAEDIATRIC AIDS ¨ ¨ Postnatal transmission via breast feeding has been found to be 14%. ¨ In developing nations, the HIV-1 epidemic begun to reverse the gains in infant and childhood morbidity and mortality, previously realized through nutrition and vaccine programmes . ,
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PAEDIATRIC AIDS ¨ ¨ VERTICAL TRANSMISSION OF HIV-1
¨ It is an important and unique aspect of pediatric AIDS ¨ HIV-1 may be transmitted to the infant during gestation (in utero), during delivery (intrapartum) or postpartum, through breast feeding. ,
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PAEDIATRIC AIDS ¨ ¨ ¨ ¨ Factors which may increase rate of vertical transmission of HIV-1 are;- 1. High viral load in the maternal circulation, 2. Maternal seroconversion just before delivery, 3. Vitamin A deficiency in mother, 4. Vaginal delivery, 5. Delivery before 34 weeks, 6. Detectable p24 antigen in maternal serum, 7. Absence of neutralizing antibodies in maternal serum,
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PAEDIATRIC AIDS ¨ ¨ 8. Maternal CD4 count less than 700/cmm or the
CD4 + CD8+ ratio less than 0.6
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PAEDIATRIC AIDS ¨ ¨ ETIOPATHOGENESIS
¨ HIV genome is single stranded RNA virus, 9.8 kb in size ¨
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PAEDIATRIC AIDS ¨ HIV selectively binds to cells expressing CD4 molecule on their surface-primarily T4 lymphocytes (CD4+ cells) ¨ Acts by REVERSE TRANSCRIPTASE ¨ Cause intense viremia ¨ Following cellular and humoral response within 1 week to 3 months, viral load decreases- PHASE OF CLINICAL LATENCY ¨ Patient undergo gradual deterioration of immune system with depletion of CD4+ cells ¨ More prone for opportunistic infections ¨
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PAEDIATRIC AIDS ¨ CLINICAL FEATURES
¨ Pattern of disease expression and progression is quite variable in HIV-1 infected children. ¨ percent develop profound immunodeficiency and AIDS defining illnesses before the first year of life and two thirds having more slowly progressive course from to 10 years. ¨ Age of onset of any sign of HIV-1 infection predicts length of survival. ¨
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PAEDIATRIC AIDS ¨ Clinical manifestations are the result of multi-system involvement associated with chronic persistent viral infection and secondary immunodeficiency. ¨ Failure to thrive, unexplained persistent fever,hepatosplenomegaly, parotitis, persistent & invasive oral thrush, recurrent gastroenteritis, otitis media, lymphadenopathy are the common early and mild signs and symptoms. ¨
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PAEDIATRIC AIDS ¨ ¨ LIP-lymphoid intertial pneumonia, organ specific infections and dysfunctions, repeated severe bacterial infections, loss of developmental milestones, meningitis, encephalopathy, idiopathic thrombocytopenia are commonly seen. ¨ Any prolonged unexplained illness should raise a suspicion of HIV-1 infection ¨
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PAEDIATRIC AIDS ¨ ¨ OPPORTUNISTIC INFECTIONS
¨ Occur as CD4+ count declines. ¨ PNEUMOCYSTIS CARINII (PCP) is the most common and lethal opportunistic infection in pediatric population. ¨ ORAL CANDIDIASIS is the most common fungal infection, may involve oesophagus-vomiting,fever,dysphagia and anorexia ¨
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PAEDIATRIC AIDS ¨ ¨ INTERSTITIAL CRYPTOSPORIDIOSIS –severe chronic diarrhoea and malnutrition ¨ ATYPICAL MYCOBACTRIAL INFECTION with Mycobacterium avium intracellulare complex(MAC) ¨ TOXOPLASMA GONDII, ¨ HERPES SIMPLEX,VARICELLA ZOSTER, CMV,MEASLES ¨
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PAEDIATRIC AIDS DIAGNOSIS OF HIV-1 INFECTION IN CHILDREN
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PAEDIATRIC AIDS DIAGNOSIS OF HIV-1 INFECTION IN CHILDREN
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