1. HIV/AID awareness by Dr PZ Buthelezi-Mlambo

2. 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

3. 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

5. 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

6. 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:

8. 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

10. 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 copies/ml (4) is regarded as confirmation of HIV infection if PCR is positive

12. 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 

13. 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

15. 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

16. 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