1. Review of HIV and Opportunistic Infections (OI) in Children
MCCC/HAKS
Pediatric Staff Training
October 2007

2. Review of HIV What is HIV? Human Immunodeficiency Virus
A virus is a germ or microbe
It enters the body and starts to grow bigger and bigger

3. Review of HIV (2)
The Immune system is like a house that protects a patient

4. Review of HIV (3)
HIV enters the body and takes over the normal immune defenses

5. Review of HIV (4)
When HIV takes over a person’s immune system they can not defend themselves against infections that normally do not cause bad disease (Opportunistic Infections)

6. Review of HIV (5) HIV grows and the person starts to: Lose weight
Cough
Fevers
Diarrhea
Difficulty breathing
Skin Rashes
Night sweats
And many other problems

7. Review of HIV (6)
When a child with HIV develops certain infections or if their immune (CD4) cells drop below a certain percentage, they have AIDS
Acquired Immunodeficiency Syndrome
Can not be cured
If they take medicine every day they can become better and stay well for a long time

8. Review of HIV (7)
ARV medicine rebuilds the immune system by fighting the HIV Virus
OI medicine helps prevent infection until the immune system is strong again

9. Case #1 6 mo female, mother HIV+, child not tested Fever to 39 RR 70
Retractions
Cough
O2 saturation 85%
XRay

10. Case #1 - PCP Differential Diagnosis Bacterial pneumonia
Viral pneumonia (CMV)
Fungal pneumonia (cryptococcus, candida) TB
PCP

11. Case #1 - PCP PCP Prophylaxis Treatment
Most common AIDS indicator disease of children (33%)
Peak incidence age 3-6 months
CD4 count not correlated with PCP infection
Prophylaxis
All children born to HIV+ women should be started on Trimethoprim/Sulfamethoxazole
Treatment
Trimethoprim/Sulfamethoxazole 15-20mg/kg divided 3 times a day x 21 days (IV or PO)
Oxygen, Prednisone 1mg/kg x bid for 5 days, 0.5 mg/kg bid for 5 days, 0.5mg qd for 5 days (give albendazole to treat strongyloides infection prior to prednisone)

12. Case #2
5 yo male with HIV+, not on ARV, CD4 count 100 (8%), presents with 3 weeks of
Blurry vision
Persistent Right red eye
No pain in eyes
Fatigue
Weight Loss

13. Case #2 - CMV Retinitis
Approximately 50% of AIDS patients will have some form of ocular involvement during the course of their disease. Remain highly suspicious of any such patient complaining of a vision change. They may be harboring CMV retinitis, Toxoplasmosis or even candidiasis to name but a few. A fundus exam followed by a referral is strongly recommended.

14. Case # 2 - CMV More likely to present with low CD4 count (< 100)
CMV/HIV coinfection worse prognosis
Often no symptoms in young children, older children complain of blurry vision,floaters
Can affect lungs, liver, Gastrointestinal tract
Treatment: Ganciclovir 5mg/kg/dose IV twice a day for 21 days OR Intraocular Ganciclovir injections

15. Case #3
1 year old female, mother HIV+, child not yet tested presents with
Fever
Poor feeding
Irritability
Mouth & tongue ulcers

16. Case #3 - Herpes

17. Case #3 - Herpes
HIV+ children can have recurrent ulcers in mouth and tongue
With severe disease can affect
All skin
Brain
Esophagus
Intestinal tract
Treatment
intravenous acyclovir (5-10 mg/kg/dose three times daily) or oral acyclovir (20 mg/kg/dose three times daily) for days

18. Case # 4 7 yo male, HIV+, not on ARV, CD 4 count 50 presents with
Weight loss
Difficulty swallowing
Sore throat

19. Case # 4 - Candida

20. Case #4 - Candida Most likely in low CD4 count (<100)
Presents with difficulty or pain with swallowing, eating, weight loss
Can disseminate to other organs (liver, spleen)
Treatment (for esophageal disease)
Fluconazole (6 mg/kg/day administered once on day 1, then 3--6 mg/kg administered once a day for a minimum of days)
Prophylaxis for CD4 <50

21. Case # 5-6
8 yo male, HIV+, on ARV for 3 years, now CD4 decreasing (150) and viral load increasing (> 150,000) presents with
Fever
Night Sweats
Cough
Lymphadenopathy
Weight loss
Abdominal pain

22. Case #5-6 TB
Diagnosed with miliary TB, treated for 9 months according to national protocol

23. Case #5-6 TB Cough improves but continues to have: Fevers Night sweats
Weight loss
Lethargy
Abdominal distension

24. Case #5-6 TB /MAC

25. Case # 5-6 TB/MAC

26. Case #5-6 TB / MAC Mycobacterium Avium Complex Treatment
Change ARV to second line since is failing first line
Treat MAC
drugs: clarithromycin or azithromycin plus ethambutol (AI).
Clarithromycin mg/kg body weight orally twice daily (maximum dose: 500 mg twice daily)
Or Azithromycin mg/kg orally once daily (maximum dose: 500 mg daily)
Plus Ethambutol is adminstered at a dose of mg/kg and is adminstered in single oral dose (maximum dose: 1.0 g)

27. Review of HIV transmission
When a person has contact with the:
Blood
Semen
Vaginal secretions
Breast milk
Of a person who is infected with HIV

28. SEX

29. Needle sticks

30. Needle sticks Sharing needles with other people - drug users
- people who reuse needles over and over on many people
Accidentally sticking yourself with a needle that someone else used

31. Wounds/cuts
If someone has a cut and you have a cut and their blood touches your cut

32. Pregnant women with HIV can give HIV to their baby
During Pregnancy
During Labor & Delivery
Breastfeeding

33. Blood transfusion

34. Ways you can not get HIV

35. Shaking Hands

36. Hugging

37. Coughing

38. Kissing

39. Eating or Drinking together

40. Mesquitoes/ Insects/ Animals

41. Sitting next to someone with HIV

42. Living with someone with HIV

43. Conclusion The best way to prevent HIV infection in children
PMTCT
Safe blood transfusions
Safer sexual practices
The best way to keep a child with HIV healthy is to
MAKE THE DIAGNOSIS!!! Test all suspicious cases!
Ensure treatment and adherence with ARV
Identify and treat Opportunistic Infections

44. THANK YOU!