12 Paediatric HIV and AIDS Voiceover.ppt

Detail of pediatrics HIV infection

1. Revision Course inRevision Course in
Paediatric HIV and AIDSPaediatric HIV and AIDS
Kolade ERNEST, FWACP(Paed.)

2. RED ALERTRED ALERT
•Effectively, in most West African Countries, ART Effectively, in most West African Countries, ART
program started after 2005. Most of the programmes program started after 2005. Most of the programmes
were mainly donor-driven fund-wise. Recently there is were mainly donor-driven fund-wise. Recently there is
demand from many of the funders for a national demand from many of the funders for a national
government take-over of the responsibilities of caring government take-over of the responsibilities of caring
for the nationals. Also funding are drying up causing for the nationals. Also funding are drying up causing
threats to universal access to prevention, treatment, threats to universal access to prevention, treatment,
care and support. This may cause real disequilibrium in care and support. This may cause real disequilibrium in
the national responses of the West African Nations to the national responses of the West African Nations to
HIV and AIDS in the very near future if situations remain HIV and AIDS in the very near future if situations remain
the same.the same.

3. West Africa: Threats
•Political Instability
•Communal conflicts
•Terrorist insurgences
•Desert encroachment & its
consequences
•Poor infrastructures
•Poorer funding

4. Virology

5. HIV is a retrovirus with a simple cellular structure made of:
•Two important membrane glycoproteins responsible for its
antigenic identity:
−HIV-1 (Gp 120 and Gp 41)
−HIV-2 (Gp 105 and Gp36).
•Three important enzymes responsible for entry into host cell,
incorporation of its RNA into host DNA, replication and
assembly of new viral particles
−Reverse transcriptase
−Integrase
−Protease.
National Paediatric ART Training Slides Unit 2 11

6. •Has an outer double lipid
membrane (envelope) lined
by matrix protein (p17)
•Surface glycoprotein gp120
and trans-membrane gp41
•The gp spikes surround the
cone-shaped protein core
(p24)
•Core protein contains
genetic material (RNA) and
enzymes.
Biology and Structure of HIV
National Paediatric ART Training Slides Unit 2 7

7. Viral enzymes
•Reverse Transcriptase (RT),
converts viral RNA into a
double stranded (DNA)
•Integrase cause integration
of double stranded DNA
into host’s DNA
•Protease splits generated
macro-proteins into smaller
viral proteins which get
incorporated into new viral
particles.
Biology and Structure of HIV
National Paediatric ART Training Slides Unit 2 8

8. •CD4+ cells play vital roles in humoral and cell-mediated
immunity such as:
–Maturation of B-cells to plasma cells to make antibodies
–Induction of natural killer (NK) cells to destroy tumour
cells
–Activation of macrophages for efficient phagocytosis
–Suppression of other T and B-cells by CD8+ suppressor T-
cells
–Lysis of infected cells by cytotoxic CD8+ T-cells.
•Continuous CD4+ loss lead to progressive
immunosuppression and increase the incidence of OIs.
Mechanism of Infection
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9. •Reduced activity of NK cells leads to increased incidence
of tumours
•Continuous viral replication leads to progressive CD4+
cell destruction which in turn results in:
–More CD4+ cell production
–Continuous infection of surviving CD4+ cells
•CD4+ cells become eventually overwhelmed and the
immune system fails to cope with opportunistic
infections, leading to progression to AIDS.
Mechanism of Infection
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10. •HIV-1 targets CD4+ receptor and chemokine co-
receptors on T-helper lymphocytes to gain entry
into human host cells
•Destruction of CD4+ cells causes progressive
immunosuppression and increased incidence of OIs
•The CD4+ cells are eventually overwhelmed and
the immune system fails, leading to disease
progression to AIDS.
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11. •Infant factors:
–Infecting viral dose
(maternal VL)
–Infection before 4
months of life
–Infant peak viraemia
–Rapid decline in CD4+
–Clinical AIDS
–p24 antigenaemia.
•Maternal factors:
–VL at time of delivery
–CD4+ count (<200)
–Rapidly progressive
disease
–Maternal death.
Factors Predicting Disease Progression

12. HIV infection is acquired in children through:
•Mother-to-child (or vertical) route
–Accounts for >90% of transmission in children
–Can occur in-utero, at delivery or during breastfeeding
–Prolonged breastfeeding and mixed feeding are key
factors responsible for higher transmission rates in Africa
–Without intervention overall transmission rate is 30-40%.
•Sexual contact – forced or consensual
•Blood and blood product transfusion
•Use of contaminated sharps.
Modes of HIV Transmission
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13. •CD4+ count varies with age and is generally
higher in healthy children than in adults
•CD4+ counts slowly decline to adult levels by the
age of 6 years
•Both maternal and infant factors influence
disease progression
•Mother-to-child (or vertical) route accounts for
>90% of HIV transmission in children.
Key Points

14. Diagnosis

15. •Although clinical features are used to make
diagnosis of HIV infection, very often they overlap
with features of other diseases
•Confirmatory diagnosis thus depends on laboratory
tests, which can be divided into 2 categories:
–Antibody tests: cheaper and easy to perform
–Virologic tests: expensive and complex
•Breastfeeding makes diagnosis difficult in breastfed
infants, who are at risk of breastmilk transmission.
Introduction

16. WHO staging for HIV infection and
disease in infants, children and adolescents

17. •There are 4 clinical stages of HIV infection
−WHO Stage 1 (Asymptomatic)
−WHO Stage 2 (Mild)
−WHO Stage 3 (Advanced)
−WHO Stage 4 (Severe)
•Clinical staging is used along with immunologic criteria
to determine when to initiate and how to monitor
therapy.
Key Points
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18. PITC

19. •PITC refers to HIV testing and counselling offered to
children seen in health facilities
•It adopts the “opt out” approach that emphasizes the
3 Cs
‒Consent
‒Counselling
‒Confidentiality
•It is aimed at serving the best interest of the child
•Facilities offering PITC should have capacity to provide
care or appropriate referral for children diagnosed
with HIV.
Key Points
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20. OIs

21. •HIV infection if untreated may often be associated with
specific OIs or a variety of clinical conditions
•It is important to develop a high index of suspicion and
consider HIV screening in any child who presents with
recurrences of these illnesses
•Recurrences of these illnesses and conditions in
children on ART is suggestive of treatment failure
•Specific prevention for some OIs and clinical conditions
is by continuous prophylaxis.
OIs
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22. •Strategies for OI prevention include primary and secondary
drug prophylaxis, as well as immunization and general
support
•Early detection and prompt management of OIs reduces
associated morbidity and mortality and
•All HIV infected children >5 years and adolescents with CD4
counts <350/mls and/or Stage 3 and 4 AIDS should receive
CPT.
•CPT is indicated for HIV exposed infants until HIV diagnosis is
excluded
•CPT is important in preventing PCP as well as malaria, and
salmonella infections.
OIs
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23. •HIV/TB co-infection is associated with higher mortality
•High index of suspicion for TB is required in HIV
exposed or infected child
•Extra-pulmonary TB occurs more often in HIV-infected
children
•TB and HIV infections may resemble; there is significant
overlap of clinical features with those of other
infections
•HIV infection has a negative impact on the sensitivity
and specificity of commonly used criteria for diagnosis
of TB.
Key Points
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24. •HIV infection can increase the susceptibility to Hepatitis
B and C
•Co-infection with these viruses hastens progression of
HIV disease
•Use of HAART in co-infected patients should consider:
–Potential for hepato-toxicity
–Drug-drug interaction
–ARV drugs that are effective against the viruses.
Key Points
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25. •HIV infection increase the susceptibility to malignancies
and lymphoproliferative diseases
•Use of HAART is critical to the treatment of HIV-related
malignancies and should be instituted alongside
chemotherapy.
Key Points
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26. •Children with HIV infection are at high risk of developing
lympho-proliferative disorders which include :
–Lymphoid interstitial pneumonitis
–Pulmonary lymphoid hyperplasia
–Diffuse interstitial lymphocytosis syndrome
–Mucosa-associated lymphoid tumours.
•Progression to malignant lymphoma may occur
•Treatment:
–Lympho-proliferative disorders generally respond well to
HAART
–Where progression has taken place to malignancy, they
should be treated same way as HIV-related Non-Hodgkin’s
lymphoma.
Lympho-proliferative conditions
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27. ART

28. •While ARV therapy reduces HIV replication, indirectly
preserves CD4+ cell count/function and restores
immunity to fight infections…….
•It does not provide a cure for HIV.
 
•The major goals of ART in children are to:
−Stop and reverse progression of disease
−Promote or restore normal growth and development
−Improve quality of life
−Achieve optimal response with minimal toxicity
−Ensure rational ARV use to preserve future treatment
options
Introduction
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29. •Most infections in children are acquired vertically
•Such infection is associated with faster disease
progression in infancy
•Exposure to ARVs for PMTCT is important to consider in
the choice of ARVs for perinatally infected children
•Drug pharmacokinetics changes with age
•ART Adherence is key to treatment success
•Limited ART options are available for lifelong treatment.
Principles of Antiretroviral Therapy in Children
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30. •Non-nucleosides (NNRTIs) stop viral replication by
binding to reverse transcriptase preventing the
transcription of HIV RNA to DNA
•Nucleosides (NRTIs) incorporate into viral DNA to
stop replication and form incomplete viral DNA –
cannot create a new virus
•Nucleotides (NtRTIs) act at the same stage of HIV life
cycle as NRTIs, but do not require phosphorylation for
anti-HIV activity.
Classes and modes of action of ARVs
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31. •Protease inhibitors (PIs) act at the last stage of HIV
cycle
–Prevent assembly and release of HIV particles from
infected CD4 cells
•Entry (fusion) inhibitors prevent HIV from infecting
CD4 T cells
•Integrase inhibitors prevent insertion of HIV DNA
template into host DNA
–Prevents viral replication
•Chemokine receptor inhibitors prevent attachment of
HIV surface antigens to CCR5 or CCX4 receptors.
Classes and modes of action of ARVs cont…
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32. Mode and site of action of ARVs
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33. ARV CLASS APPROVED DRUGS
NRTIs
Zidovudine (ZDV, AZT)*
Lamivudine (3TC)*
Stavudine (d4T)*
Abacavir (ABC)*
Didanosine (ddI) *
Zalcitabine (ddC)
Emtricitabine (FTC)*
NtRTIs •Tenofovir (Disoproxil Fumarate {TDF})
NNRTIs
Nevirapine (NVP)*
Efavirenz (EFV)*
Delavirdine (DLV)
Etravirine (ETV) *
Fusion inhibitorsEnfuvirtide (T-20)*
PIs
Lopinavir-ritonavir (LPV/r)*
Ritonavir (RTV) {as pharmaco-
enhancer}*
Nelfinavir (NFV)*
Saquinavir (SQV)
Amprenavir (APV)*
Indinavir (IDV)
Atazanavir (AZV)*
Tipranavir (TPV)
Darunavir* (DRV)
Fos-amprenavir* (FPV)
CCR5
inhibitor
Maraviroc
Integrase
Inhibitors
Raltegravir (RAL)
Classes of ARVs (*approved for use in children)
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34. •Adverse events may vary from mild to severe or life-
threatening
•Mild toxicities do not require discontinuation of therapy or
drug substitution - treatment is symptomatic
•Moderate also do not require discontinuation or drug
substitution - treatment is symptomatic
•Severe toxicities may require substitution with a drug in
the same class but with different toxicity profile
•Life-threatening toxicity requires discontinuation of all
ARVs and the initiation of supportive therapy.
ART toxicity profile cont…..
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35. •The major classes of ARVs are NNRTIs,NRTIs and PIs
•Considerations when choosing ARV’s include:
–Adherence and ease of administration
–Potential drug interactions
–Short- and long-term adverse events.
•ARVs are usually well tolerated in children
•Adverse events vary from mild to severe or life-
threatening
•Drug interactions do occur between ARVs and
between ARVs and other drugs.
Key Points
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36. •ARV therapy reduces VL, stimulates immune recovery
and prolongs life
•Eligibility for ART initiation is assesed using the child’s
age, clinical and immunological criteria
•Identification of responsible caregiver(s), access to
nutritional support and age-specific adherence
strategies are key considerations prior to initiating ART
•Pre-treatment evaluation should include clinical,
laboratory and psychosocial assessments.
Key Points
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37. •A combination of 3 or more ARVs from at least two
different groups
•Is currently the standard treatment of HIV infection
aimed at:
–Achieving the best possible suppression of viral
replication
–Arresting the progression of the disease
–Minimizing the risk of interactions, adverse effects and
–Preserving therapeutic options for the future.
•“1
st
chance is the best chance!”
Highly Active Antiretroviral Therapy (HAART)
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38. Age Group Considerations Preferred 1
st
line
regimen
Alternative 1
st
line
regimens
Infants
No prior exposure to NNRTI’s AZT + 3TC + NVP
•ABC + 3TC + NVP
•AZT+ 3TC+ ABC
++
•d4T
*
+ 3TC + NVP
Prior exposure to NNRTI’s (e.
g. through PMTCT)
AZT + 3TC + LPV/r
** •ABC + 3TC + LPV/r
•AZT+3TC+ ABC
Unknown exposure to NNRTI’s
NB; Closely monitor for failure
AZT + 3TC + NVP
ABC + 3TC + NVP
d4T
C
+ 3TC + NVP
Children
12mos-2yrs with exposure to
NNRTI
AZT + 3TC + LPV/r
AZT+3TC+ ABC
ABC + 3TC + LPV/r
d4T
*
+ 3TC + LPV/r
12mos- 2 years with no
exposure to NNRTI
AZT + 3TC + NVP
ABC + 3TC + NVP
AZT+ 3TC+ ABC
d4T
*
+ 3TC + NVP
2 – 3 years, regardless of
NNRTI exposure
AZT + 3TC + NVP
ABC + 3TC + NVP
AZT+ 3TC+ ABC
d4T
*
+ 3TC + NVP
> 3 years AZT+3TC+EFV
*** AZT+3TC+NVP
AZT+ 3TC+ ABC
d4T
*
+3TC+NVP
ABC + 3TC + EFV
Special
Circumstances
Severe Anemia/Neutropenia Avoid AZT if Hb<8g
HBV/HCV in >12 yrs old TDF+FTC (or 3TC) + EFV
TB in children See TB Treatment
First line ARV regimen
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39. •HAART involves the use of ≥3 ARVs from at least 2
classes
•The recommended 1
st
line regimen is ZDV/3TC/NVP
or EFV – the first chance is the best
•With TB co-infection commencement of ARVs
depends on:
•When TB diagnosis is made
•Clinical condition of patient
•NVP should be substituted with EFV to avoid interaction with Rifampicin.
Key Points
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40. •There is limited data on treatment interruption in
children
•ART interruption is not encouraged, but may be
indicated in situations such as:
–Serious treatment-related toxicity
–Acute illnesses (e.g. severe diarrhoea and vomiting)
–Planned surgeries that preclude oral intake
–Patient or parent/caregiver request after extensive
counselling.
Stopping therapy and treatment interruption
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41. •Situations in which ART may be discontinued.
‒Poor adherence
‒Repeated interruptions of ART.
•Consider discontinuation only after exploring all
potentially corrective measures, including
‒Intensive counselling
‒Additional caregiver education and family support.
Stopping therapy and treatment interruption cont….
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42. •Adherence is a challenging dynamic process in
children and requires a multi-disciplinary approach
•Adherence assessment should precede initiating and
changing ART
•Optimal adherence (>95%) is key to successful
antiretroviral therapy
•Poor adherence leads to sub-optimal VL suppression
and development of HIV resistance.
Key Points
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43. Clinical & Labs Monitoring

44. Monitoring
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•Clinic follow-ups are attendances scheduled as regular
appointments to enable patient monitoring
•Summary of routine activities that should take place
during such visits include:
–Anthropometry (plotted on standard charts) and neuro-
developmental assessment
–Physical exam (pallor, jaundice, mouth, skin, lymph nodes,
chest, abdomen)
–Assessment of nutritional intake and immunizations
–Psychosocial assessment (for care-giver and child where
applicable)
–Checking for adverse drug reactions and interactions.

45. Key Points
•Baseline assessment is an essential aspect of care prior to
commencing ART
•It provides reference point of reference for further
monitoring
•The components of baseline assessment include:
–Clinical evaluation
–Laboratory evaluation
•CD4 count/CD4% measurements are essential in identifying
ART eligibility in children from 24 months to adolescence.
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46. Tiered Laboratory Monitoring capabilities
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47. Key Points
•Clinical, laboratory and adherence monitoring are
integral aspects of ART
−They help early identification of ART failure
•Anthropometric and developmental assessment if
routinely conducted, could reveal:
•Evidence of early HIV disease progression or treatment failure
•Early features of HIV encephalopathy
•Adherence assessment should be carried out using
multiple strategies and in a non-judgemental manner.
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48. Summarised schedule for ART Monitoring
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Pre-
Treatment
(Baseline)Week
2
Monthly x 6
Every 3
mo.
thereafter
Every 6
mo
thereafter1 2 3 4 5 6
Physical Exam
X X X X X X X X X
Adherence
Counselling
X X X X X X X X X
Confirm HIV status
X
HIV-1 RNA(VL)*
X X X
CD4+
X X X X
FBC
X X X X
E & U, Cr*
X X
LFT
X X** X X X
Random BS*
X
Serum lipids*
X
Amylase*
X
Urinalysis
X X X X X X X X
Chest X-ray*
X
*As clinically indicated, thereafter ** To be done for children starting on NVP

49. Care & Support

50. Introduction
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•Care and support services are essential components in
the management of HIV infected and affected children
•A comprehensive child-centred and family-focused
approach beyond just ART for the infected child is
considered as basic standard for HIV care and support
•Care in the context of HIV is best accomplished by
integration with primary health care and social services.

51. OVC
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•The HIV/AIDS pandemic has led to an increase in the population
of OVC
•Children with inadequate access to welfare, educational and
social support services are considered vulnerable
•The most essential support services required for OVC care are:
‒Health care
‒Food and nutrition support
‒Education and vocational support
‒Psychosocial support
‒Provision of shelter
‒Household economic strengthening
‒Protection including legal support.

52. Counseling
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•Counselling in the care of HIV infected children aims to
meet the specific need for which it was sought
•A counsellor should possess and employ skills for
“Listening and learning” as well as those for “giving
support”
•While a similar approach could be applied in
counselling interactions the contents to discuss
depend on the particular need
•It is important to address adherence issues with
caregiver before commencing ART and on-going
counselling.

53. Disclosure
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•Disclosure entails more than revealing HIV status to a
child
•It is an on-going dialogue on health and related issues
between caregiver and child based on his/her capabilities
•Although a primary role of caregivers, health teams
should empowering caregivers and facilitate its process
early
•The benefits of early disclosure includes:
−Reduction of risk of developing fantasies
−Improving access to care
−Enhancing treatment adherence and
−Reduction of negative psychological impacts of HIV.

54. Psychosocial Support
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•HIV infected/affected children have special
psychosocial needs
•The periods of increased psychosocial vulnerability are
at times of diagnosis, during episodes of illness and
bereavement
•Psychosocial needs should be addressed from
perspectives of child, caregiver and health care
provider.

55. Education & Vocational Training
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•Formal education is a priority for all children including
those living with HIV
•Education acts as a “social vaccine” against HIV
•Adolescents require vocational and life skills education
skills training which should be offered from age of 10
years.
•Efforts should be made to identify and eliminate
potential barriers that could limit access to education.

56. Immunization
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•HIV exposed children and those with asymptomatic
infection can safely receive all vaccines according to NPI
schedule
•Measles vaccine should be administered first at 6
months and then at 9 months
•Children with advanced disease or AIDS Stages 3 and 4
or severe immunosuppression should not be given live
vaccines: BCG, OPV, measles, Yellow fever vaccines
–Live vaccines could cause fatal disseminated disease due to
infection by vaccine strain

57. Immunization Schedule…..cont….
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VaccineAsymptomatic
HIV infection
Symptomatic
HIV infection
Optimal timing of
immunisation
BCG Yes No At birth
DPT Yes Yes 6, 10, 14 Weeks
OPV Yes No 0, 6, 10, 14 Weeks
HBV Yes Yes Birth, 6 and 14
weeks
Measles Yes No 6, 9 Months
Yellow
fever
Yes No 9 months

58. Palliative and Home-Based Care

59. Basic Care Kit
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A set of health promotion items packaged together for
use in the home by PLHIV as a Basic Care Kit, made of:
•Long lasting ITN
•IEC materials
•ORS and SSS educational materials
•Water vessel
•Water treatment solution
•Disposable Gloves
•Soap
•Condoms.

60. Management of Common Conditions
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Symptoms Causes Management
Nausea,
vomiting
•Drugs
•GIT infections
•Fever
Small frequent feeds, fluids between meals
Eat before taking medications, dry foods
Avoid sweet, fatty, salty, or spicy foods
Sore mouth Herpes simplex
Aphthous ulcers
Thrush
Gingivitis
Keep mouth clean; use soft cloth or gauze
in clean salt water.
Give clear water after feeds; avoid acidic
drinks and hot food
Give pap, sour milk or porridge, crushed
ice cubes may help;
Ice cream or yoghurt, if available
Chronic
Diarrhoea
Infections
Malabsorption
Malignancies
Drug-related
Rehydration using ORT
Diet modification (e.g. yoghurt rather than
fresh milk)
Micronutrient supplements (zinc, vit A)

61. Management of Common Conditions
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Symptoms Causes
Management
Persistent
Cough
Infections
Allergy
LIP
Bronchiectasis
Depending on the cause:
Antibiotics
Nebulization with
salbutamol/saline for LIP
Physiotherapy
Dermatitis Infections and infestations
Hypersensitivity
Malignancies
Emollients, corticosteroids,
anti-histamines
Antiseptics
Keep nails short to minimize
trauma from scratching
Convulsions Infections and infestations
Encephalopathy
Malignancies
Progressive multifocal
leuko-encephalophathy
Metabolic disorders
Anticonvulsants
Wounds Trauma
Infections
Pressure
Malnutrition
Wound dressing with honey
Frequent turning and massage
of pressure areas
Manage malnutrition

62. Key Points
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•HBC is an integral aspect of HIV-related care and
support for children provided in their communities
•Through a multidisciplinary approach, the HBC
Team provides a range of services from
psychosocial support to terminal care
•Expert clients could be made to compliment HBC
support services in many effective ways.

63. Household Economic Empowerment

64. Household Economic Strengthening
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Aims at:
•Building the economic capacity of HIV affected families
to support their children
•Establishing micro-finance projects that benefit
households
•Improving agricultural productivity and efficiency among
households with PLHIV or where HIV related deaths have
occurred
•Providing apprenticeships, vocational and life skills
training for young people.

65. Infant Feeding in Context of HIV

66. Infant Feeding
•Nutrition for HIV-exposed infants is aimed at:
−Reducing the risks of breast milk HIV transmission
−Preventing morbidity from unsafe feeding practices
•Infant feeding counselling should begin at ANC and followed-
up with complimentary feeding counselling in infancy
•EBF and continued BF for up to 12 months while mother/child
is on ARVs makes BF:
−Safer from risk of post-natal MTCT
−Safer from complications of faulty feeding
−Guarantees HIV free child survival for most HIV infected children.
•The advantages/safety of BF should be used as reasons to
recommend this option
•Mothers who opt for formula and meet AFASS criteria should
be supported to safely feed their babies.
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67. Risk factors for postnatal HIV transmission
The risk of post-natal (breastmilk) HIV transmission is
increased by:
•Maternal HIV disease severity
•High maternal viral load
•Maternal HIV acquired in the postnatal period
(including re-infection)
•Presence of maternal cracked nipples and mastitis
•Presence of sores in the infant’s mouth.
•Mixed feeding in the 1
st
6 months of life
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68. Infant feeding in the first 6 months of life
HIV positive mothers whose infants are HIV
uninfected or of unknown HIV status should be
counselled to:
•Either exclusively breastfeed their infants for
the first 6 months of life (while on ARVs),
Or
•Feed their babies exclusively with commercial
infant formula and completely avoid
breastfeeding from birth (any form of
breastmilk).
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69. AFASS
•Acceptable:
–Mother perceives no problem in replacement feeding –
cultural, social, fear of stigma and discrimination
•Feasible:
–Adequate time, knowledge, skills, resources and support to
correctly mix formula and feed up to 12 times in 24 hours
•Affordable:
–She can afford cost of replacement feeding with no effect on
family resources (with community/facility support)
•Sustainable:
–A guarantee for continuous supply of all items needed for safe
formula feeding for up to one year of age or longer
•Safe:
–Infant formula can be correctly and hygienically prepared and
fed preferably by cup.
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70. Nutrition Mgt
•Malnutrition and HIV infection work in a vicious cycle to
suppress immunity and lead to rapid disease
progression
•Both impact significantly on daily requirements, intake
and utilization of macro and micronutrients
•Mothers should be supported to manage feeding
difficulties of children using simple measures at home.
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71. Key Points
•Severe malnutrition contributes significantly to
morbidity and mortality in HIV infected children
•Early identification and management is required for a
successful outcome
•Severely malnourished children should be admitted
and managed in a step-wise approach
−Resuscitation phase of up to 2-4 weeks
−Stabilization or rehabilitation phase of 6-8 weeks.
•Caregivers should be assisted to maintain child’s home
recovery at discharge
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72. Key Points
•Household food security for families is key to
survival and development of HIV infected
children
•Food security should be routinely assessed for
families to determine the need for advise or
referral for community support accordingly.
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73. UPDATESUPDATES

74. HIV Infection and COVID-19
•Characteristically, the children LWHA have:
–Higher incidence and severity of
respiratory virus infection such as
Influenza.
–Higher need for in-hospital care where
they may spend longer periods than
general population.

75. HIV Infection and COVID-19
•HIV patients were not initially reported
to be at higher risk of COVID-19 disease
due probably to Protease inhibitors that
may have some activities against the
Acute Respiratory Syndrome Coronavirus
2 (SARS-CoV2) the causative agent of
COVID-19.

76. HIV Infection and COVID-19
•COVID-19 has the potential to cause disruption
in health care services through:
–Overwhelming number of patients with
disease,
–Interventions for pandemic use up available
healthcare resources including manpower,
preventive services discontinued and
decreased production and supply of medicine
and medicaments.

77. HIV Infection and COVID-19
Definite impacted on other services include;
•ART supply interruption
•Decreased ART enrolment
•Laboratory monitoring interception
•Contact tracing interception
•Counselling and social support interruption
•Poor or reduced access to clinical evaluations

78. Thanks for your AttentionThanks for your Attention