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Module 4 hiv infection & art in children

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David Ngogoyo
Saúde e medicina
1 de 169
Management of HIV infected Children
 
HIV in Children ,[object Object],[object Object],[object Object],[object Object],[object Object]
Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management of HIV infected Children Unit 1 Epidemiology and HIV transmission in Children
Objective of Unit 1 ,[object Object],[object Object]
Epidemiology - Kenya ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Modes of HIV transmission in Children ,[object Object],[object Object],[object Object],[object Object],[object Object]
Modes of HIV transmission to Children ,[object Object],[object Object],[object Object],[object Object]
Mother to Child HIV Transmission 30% babies born to HIV+ women become infected through MTCT 5% intrauterine 10-20% during delivery 10-20% via breastfeeding
Modes of HIV transmission to Children ,[object Object],[object Object],[object Object],[object Object],[object Object]
Management of HIV infected Children Unit 2: Natural history of HIV in Children
Objective of Unit 2 ,[object Object],[object Object]
Natural history – patterns of disease progression in African children ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Natural history – patterns of disease progression in African children ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Natural History – Immunological changes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Natural History – Immunological changes
Natural History – Immunological changes
Natural History – Viral load patterns in children ,[object Object],[object Object],[object Object],[object Object],[object Object]
Management of HIV infected Children Unit 3 Diagnosis and Staging of HIV in Children
Diagnosis and Staging of Paediatric HIV -scope ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
I: Clinical presentation of HIV in Children ,[object Object],[object Object]
Clinical suspicion of HIV ,[object Object],[object Object]
Clinical signs & conditions suggestive of HIV infection in a child (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical signs & conditions suggestive of HIV infection in a child (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical signs & conditions Common in both HIV+ and HIV- children ,[object Object],[object Object],[object Object],[object Object],[object Object]
Entry points for HIV diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IMCI definition of symptomatic HIV infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DIAGNOSIS OF PEDIATRIC HIV
Laboratory Diagnosis ,[object Object],[object Object],[object Object]
Laboratory Diagnosis Child >18 months ,[object Object],[object Object],[object Object]
Laboratory Diagnosis Child < 18 months ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laboratory Diagnosis Virologic tests ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When to do PCR for HIV diagnosis of Child < 18 months ,[object Object],[object Object],[object Object],[object Object]
When to do PCR for HIV diagnosis of child <18 months ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Interpretation of laboratory diagnosis ,[object Object],[object Object],[object Object],[object Object]
HIV Diagnosis before age 18 month without virologic test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DIAGNOSIS - summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
STAGING PEDIATRIC HIV Clinical and Immunological
Clinical Staging ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Staging Severe (AIDS) 4 C Moderate 3 B Mild 2 A Asymptomatic 1 N Stage WHO CDC
WHO Clinical Staging – stage 1 ,[object Object],[object Object],[object Object]
WHO Clinical Staging - stage 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
WHO Clinical Staging – Stage 3 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
WHO Clinical Staging – Stage 3 (continued) ,[object Object],[object Object],[object Object],[object Object],[object Object]
WHO stage 4 – all ages ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WHO stage 4 – all ages (continued) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WHO-Presumptive severe HIV infection: Child < 18 months requiring ART- when PCR testing not available ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Exercise on clinical staging ,[object Object],[object Object],[object Object]
Exercise on Clinical Staging ,[object Object]
Exercise on Clinical Staging ,[object Object],[object Object],[object Object]
Exercise on Clinical Staging ,[object Object],[object Object]
Immunological Staging ,[object Object],[object Object],[object Object],[object Object]
Indicators of severe Immunosuppresion (WHO 2006) <2000 <2500 <3000 <4000 By total lymphocyte count <200 <350 <750 <1500 By CD4 count <15% <15% <20% <25% By CD4% 5yr+ 36-59 months 12-35 months < 12 months Severe immuno-suppression
NASCOP 2007- classification of severe immunosuppresion in children ,[object Object],[object Object]
Immunological Staging Using CD4 percentage <250 < 500 < 1500 By CD count <15% <20% <25 % By CD4% > 5 years (60 months) CD4 % 18 months-59 months CD4 % < 18 months CD4 % Severe immunosuppression
Total Lymphocyte Count (TLC) ,[object Object],[object Object],[object Object]
Computing Total Lymphocyte Count ,[object Object],[object Object],[object Object],[object Object]
Computing Total Lymphocyte Count ,[object Object],[object Object]
Computing Total Lymphocyte Count ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Computing CD4% ,[object Object],[object Object],[object Object],[object Object]
Management of HIV infected Children Unit 4 HIV – Related Conditions: Prevention and Treatment
Diagnosis – combining lab and clinical criteria ,[object Object],[object Object]
Summary of approach to diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Unit 4: HIV related conditions ,[object Object]
HIV-related Diseases ,[object Object],[object Object],[object Object],[object Object],[object Object]
HIV-related Diseases (cont) ,[object Object],[object Object],[object Object],[object Object]
Respiratory Infections in HIV infected children ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infections causing diarrhoea in HIV infected Children ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infections causing diarrhoea in HIV infected children ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Measles ,[object Object],[object Object],[object Object],[object Object]
Measles ,[object Object],[object Object],[object Object]
Septicemia and Meningitis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Skin infections ,[object Object],[object Object],[object Object],[object Object]
Multiple skin abscesses Photo courtesy of Israel Kalyesubula
Malaria ,[object Object],[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object]
Opportunistic Infections ,[object Object],[object Object],[object Object],[object Object]
Prevention of Opportunistic Infections ,[object Object]
Immunization of HIV Infected Child ,[object Object],[object Object],[object Object],[object Object]
World Health Organization/UNICEF recommendations For the Immunization of HIV-infected children and women of childbearing age
* IPV an alternative for children with symptomatic HIV ** Pending further studies WHO/UNICEF Recommendations for HIV Infected Children No** Yes Yellow fever As for uninfected children Yes Yes Hepatitis B 6 and 9 months Yes Yes Measles 0, 6,10,14 wks Yes Yes OPV* 6,10,14 wks Yes Yes DPT Birth No Yes BCG Optimal timing of immunization Symptomatic HIV Asymptomatic HIV Vaccine
Immunization of HIV infected infants ,[object Object],[object Object],[object Object],[object Object]
Chemoprophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object]
TB Chemoprophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pneumocystis Pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object]
Management of PCP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PCP Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PCP Prophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cotrimoxazole reaction and management
Candidiasis ,[object Object],[object Object],[object Object]
 
Treatment of Candidiasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment of Candidiasis ,[object Object],[object Object],[object Object]
Photo courtesy of Israel Kalyesubula
 
Coccidioidomycosis
Katindi – 6 years ,[object Object],[object Object],[object Object],[object Object]
Katindi ,[object Object],[object Object],[object Object]
Katindi ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management of HIV infected Children Unit 5 Antiretroviral Therapy in Children
Unit 5 Antiretroviral Therapy in Children ,[object Object]
Antiretroviral Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Criteria for ART Initiation ,[object Object],[object Object],[object Object]
Criteria for ART Initiation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Criteria For ART Initiation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Preparing a Child for ART ,[object Object],[object Object],[object Object]
Preparing a Child for ART (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Preparing a Child for ART (3) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prior to starting ARV in children ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prior to starting ARV in children- cont.. ,[object Object],[object Object],[object Object],[object Object]
Goals of ARV Therapy ,[object Object],[object Object],[object Object],[object Object]
Special Considerations for Children and ARVs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Types of Antiretroviral Drugs ,[object Object],[object Object],[object Object]
Antiretroviral Agents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antiretroviral Agents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Kenya national recommended 1st line ART in children ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
First line regimen in NVP-exposed child ,[object Object],[object Object]
ART and Tuberculosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Dosages of ARV drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NRTIs I No food restrictions Syrup stable at 15-25 o x 1mth Not to be used with d4T Dose adjustment in Renal/Hepatic Failure ,[object Object],[object Object],[object Object],[object Object],Syrup 10mg/ml, 240ml; Caps/Tab 100mg, 300mg; Inj. IV 10mg/ml, 5ml; FDCs Zidovudine ,[object Object],[object Object],[object Object],Well tolerated May be associated with hepatitis 4mg/kg/dose BD, >12yrs or 60kg+ 150mg BD Oral solution 10mg/ml, 100mls, 240mls; Tablets 150mg FDCs Lamivudine ,[object Object],[object Object],[object Object],[object Object],Peripheral neuropathy; lipodystrophy 1mg/kg/dose BD Max: 30 mg Syrup 1mg/ml, 200ml; Caps 15, 20,30mg FDCs Stavudine Comments Adverse effects Dose Formulation Drug
NRTIs II Take on empty stomach (>1/2 hour pre or> 2hour post meal) ,[object Object],[object Object],[object Object],100-120 mg/m 2 /dose BD Dispersible buffered tablets 25/100/200mg/400mg Chewable/dissolved in water/apple juice Didanosine Not recommended in combination with ddI, if used, close monitoring needed Take with meal Well tolerated Renal impairment reported 300 mg OD Tabs 300mg FDC with Emtricitabine Tenofovir 1.Not to be used in children< 3mths 2.No food restrictions 3.Educate patient/carer re: hypersensitivity reaction 3. DO NOT re-challenge after reaction Hypersensitivity reactions (i.e. rash, fever, GI and RT symptoms) 8mg/kg/dose BD, max 300mg BD. Over 37.5kg or over 16 years: 300mg BD Oral solution 20mg/ml, 240ml; Tablets 300mg Abacavir Comments Adverse effects Dose Formulation Drug
NNRTIs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Capsules 50mg/200mg/600mg Syrup 30mg/ml., 180ml Efavirenz Store suspension at room temperature. Need to monitor LFTs in first few months Educate patient/carer about rash. Auto induced metabolism in the first 2-4 weeks with a 2 fold increase in clearance hence higher dosing after 2 weeks. ,[object Object],[object Object],4mg/kg OD for 14 days, then 7mg/kg BD for <8yrs. For >8 years 4mg/kg BD max 200mg Oral Suspension 10mg/ml, 100mls, 240ml Tablets 200mg Nevirapine Comments Adverse effects Dose Formulation Drug
PIs Separate from buffered ddI by 2hours Take on empty stomach (1 hr pre or 2hr post meals) No food effect when taken with RTV ,[object Object],[object Object],[object Object],800 mg TDS OR 800mg with RTV BD 200, 333, 400mg capsules Indinavir Food increases levels by 2-3X. Take with meals, preferably high fat meal ,[object Object],[object Object],55-75mg/kg/dose BD, max 1250mg BD Or 750mg TDS 250 mg capsules 50mg/g oral powder Nelfinavir Refrigerate reconstituted solution. Stable for 30 days. Give with food. Moderate fat meal increases bioavailability. Storage at <25 O C for up to 2 months ,[object Object],[object Object],[object Object],[object Object],7-15kg-0.15ml/kg BD 15-40kg-0.125ml/kg BD > 40kg: 3 capsules BD (400/100) Capsules 133.3mg/33.3mg Oral solution 80mg/20mg per ml Lopinavir/ritonavir (Kaletra TM ) Used as PI booster. Refrigeration required if solution or caps kept for > 30 days Oral solution contains alcohol 12%. ,[object Object],[object Object],[object Object],[object Object],Now used predominantly as a mini-dose for purposes of “boosting” other PIs 100 mg capsule Syrup 80mg/ml Ritonavir Comments Adverse effects Dose Formulation Drug
Clinical Monitoring ,[object Object],[object Object],[object Object],[object Object],[object Object]
Laboratory Monitoring ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When to change or stop ART ,[object Object],[object Object],[object Object]
When to change ART ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Indications for change of therapy – treatment failure ,[object Object],[object Object],[object Object],[object Object],[object Object]
Indications for change of therapy – treatment failure ,[object Object],[object Object],[object Object]
Indications for change of therapy – treatment failure ,[object Object],[object Object]
Second line therapy – factors to consider ,[object Object],[object Object],[object Object],[object Object],[object Object]
Kenya national recommended 2 nd line ART in children ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When To Stop/withdraw ART. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Immune Reconstitution Inflammatory Syndrome (IRIS) ,[object Object],[object Object]
IRIS-cont.. ,[object Object],[object Object],[object Object]
IRIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Module 7 Case Studies Patient MO
MO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MO ,[object Object],[object Object],[object Object],[object Object],[object Object]
MO ,[object Object],[object Object],[object Object],[object Object],[object Object]
MO ,[object Object],[object Object],[object Object],[object Object]
MO ,[object Object],[object Object]
Adherence Issues to Consider ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Studies Module 7 HIV-Related Diseases Case - Katindi
Katindi – 6 years ,[object Object],[object Object],[object Object],[object Object]
Katindi ,[object Object],[object Object],[object Object]
Katindi ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CASE PRESENTATION: SK
CASE SMK BORN JUNE 2002. ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]

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Semelhante a Module 4 hiv infection & art in children

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Mais de David Ngogoyo

Unit 1 hiv and reproductive health
Unit 1 hiv and reproductive healthUnit 1 hiv and reproductive health
Unit 1 hiv and reproductive health
David Ngogoyo
 
Unit 1 hiv and reproductive health
Unit 1 hiv and reproductive healthUnit 1 hiv and reproductive health
Unit 1 hiv and reproductive health
David Ngogoyo
 
Unit 2 mtct and prevention strategies
Unit 2 mtct and prevention strategiesUnit 2 mtct and prevention strategies
Unit 2 mtct and prevention strategies
David Ngogoyo
 
Unit 4 care of the hiv infected mother
Unit 4 care of the hiv infected motherUnit 4 care of the hiv infected mother
Unit 4 care of the hiv infected mother
David Ngogoyo
 
Unit 6 infant feeding and pmtct
Unit 6 infant feeding and pmtctUnit 6 infant feeding and pmtct
Unit 6 infant feeding and pmtct
David Ngogoyo
 
Unit 1 hiv and reproductive health
Unit 1 hiv and reproductive healthUnit 1 hiv and reproductive health
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Unit 5 drug regimens for pmtct
Unit 5 drug regimens for pmtctUnit 5 drug regimens for pmtct
Unit 5 drug regimens for pmtct
David Ngogoyo
 
Unit 3 counseling for pmtct
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Module 10 hiv and aids legal and ethical issues gsn
Module 10 hiv and aids legal and ethical issues gsnModule 10 hiv and aids legal and ethical issues gsn
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Module 10 hiv-aids legal & ethical issues
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Module 10 hiv-aids legal & ethical issues
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Module 9 adherence & psychosocial counselling
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Module 7 prevention of hiv
Module 7 prevention of hivModule 7 prevention of hiv
Module 7 prevention of hiv
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Module 5 comprehensive care gsn
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Module 5 comprehensive care gsn
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Module 8 nutrition and hiv 2
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Participants workbook
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Facilitators workbook
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Mais de David Ngogoyo (20)

Unit 1 hiv and reproductive health
Unit 1 hiv and reproductive healthUnit 1 hiv and reproductive health
Unit 1 hiv and reproductive health
 
Unit 1 hiv and reproductive health
Unit 1 hiv and reproductive healthUnit 1 hiv and reproductive health
Unit 1 hiv and reproductive health
 
Unit 2 mtct and prevention strategies
Unit 2 mtct and prevention strategiesUnit 2 mtct and prevention strategies
Unit 2 mtct and prevention strategies
 
Unit 4 care of the hiv infected mother
Unit 4 care of the hiv infected motherUnit 4 care of the hiv infected mother
Unit 4 care of the hiv infected mother
 
Unit 6 infant feeding and pmtct
Unit 6 infant feeding and pmtctUnit 6 infant feeding and pmtct
Unit 6 infant feeding and pmtct
 
Unit 1 hiv and reproductive health
Unit 1 hiv and reproductive healthUnit 1 hiv and reproductive health
Unit 1 hiv and reproductive health
 
Unit 5 drug regimens for pmtct
Unit 5 drug regimens for pmtctUnit 5 drug regimens for pmtct
Unit 5 drug regimens for pmtct
 
Unit 3 counseling for pmtct
Unit 3 counseling for pmtctUnit 3 counseling for pmtct
Unit 3 counseling for pmtct
 
Module 10 hiv and aids legal and ethical issues gsn
Module 10 hiv and aids legal and ethical issues gsnModule 10 hiv and aids legal and ethical issues gsn
Module 10 hiv and aids legal and ethical issues gsn
 
Module 10 hiv-aids legal & ethical issues
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Module 10 hiv-aids legal & ethical issues
 
Module 9 adherence & psychosocial counselling
Module 9 adherence & psychosocial counsellingModule 9 adherence & psychosocial counselling
Module 9 adherence & psychosocial counselling
 
Module 7 prevention of hiv
Module 7 prevention of hivModule 7 prevention of hiv
Module 7 prevention of hiv
 
Module 5 comprehensive care gsn
Module 5 comprehensive care gsn Module 5 comprehensive care gsn
Module 5 comprehensive care gsn
 
Module 8 nutrition and hiv 2
Module 8 nutrition and hiv 2Module 8 nutrition and hiv 2
Module 8 nutrition and hiv 2
 
Participants workbook
Participants workbookParticipants workbook
Participants workbook
 
Participants notes
Participants notesParticipants notes
Participants notes
 
Indicators manual
Indicators manualIndicators manual
Indicators manual
 
Facilitators workbook
Facilitators workbookFacilitators workbook
Facilitators workbook
 
Facilitators guide
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Art hmis tot training thika-photos
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Module 4 hiv infection & art in children

  • 1. Management of HIV infected Children
  • 2.  
  • 3.
  • 4.
  • 5. Management of HIV infected Children Unit 1 Epidemiology and HIV transmission in Children
  • 6.
  • 7.
  • 8.
  • 9.
  • 10. Mother to Child HIV Transmission 30% babies born to HIV+ women become infected through MTCT 5% intrauterine 10-20% during delivery 10-20% via breastfeeding
  • 11.
  • 12. Management of HIV infected Children Unit 2: Natural history of HIV in Children
  • 13.
  • 14.
  • 15.
  • 16.
  • 17. Natural History – Immunological changes
  • 18. Natural History – Immunological changes
  • 19.
  • 20. Management of HIV infected Children Unit 3 Diagnosis and Staging of HIV in Children
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.
  • 39. STAGING PEDIATRIC HIV Clinical and Immunological
  • 40.
  • 41. Clinical Staging Severe (AIDS) 4 C Moderate 3 B Mild 2 A Asymptomatic 1 N Stage WHO CDC
  • 42.
  • 43.
  • 44.  
  • 45.
  • 46.  
  • 47.
  • 48.
  • 49.
  • 50.
  • 51.
  • 52.
  • 53.
  • 54.
  • 55.
  • 56. Indicators of severe Immunosuppresion (WHO 2006) <2000 <2500 <3000 <4000 By total lymphocyte count <200 <350 <750 <1500 By CD4 count <15% <15% <20% <25% By CD4% 5yr+ 36-59 months 12-35 months < 12 months Severe immuno-suppression
  • 57.
  • 58. Immunological Staging Using CD4 percentage <250 < 500 < 1500 By CD count <15% <20% <25 % By CD4% > 5 years (60 months) CD4 % 18 months-59 months CD4 % < 18 months CD4 % Severe immunosuppression
  • 59.
  • 60.
  • 61.
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  • 64. Management of HIV infected Children Unit 4 HIV – Related Conditions: Prevention and Treatment
  • 65.
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  • 77. Multiple skin abscesses Photo courtesy of Israel Kalyesubula
  • 78.
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  • 81.
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  • 83. World Health Organization/UNICEF recommendations For the Immunization of HIV-infected children and women of childbearing age
  • 84. * IPV an alternative for children with symptomatic HIV ** Pending further studies WHO/UNICEF Recommendations for HIV Infected Children No** Yes Yellow fever As for uninfected children Yes Yes Hepatitis B 6 and 9 months Yes Yes Measles 0, 6,10,14 wks Yes Yes OPV* 6,10,14 wks Yes Yes DPT Birth No Yes BCG Optimal timing of immunization Symptomatic HIV Asymptomatic HIV Vaccine
  • 85.
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  • 95.  
  • 96.
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  • 98. Photo courtesy of Israel Kalyesubula
  • 99.  
  • 101.
  • 102.
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  • 104. Management of HIV infected Children Unit 5 Antiretroviral Therapy in Children
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  • 141. Module 7 Case Studies Patient MO
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  • 148. Case Studies Module 7 HIV-Related Diseases Case - Katindi
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Notas do Editor

  1. If infant negative, repeat tests after 3-6 months. If infant still breastfeeding, wait until 3 months after cessation of breastfeeding to confirm final HIV status.
  2. Gross case of hairy leukoplakia on the lateral border of the tongue. It appears as a corrugated white keratotic lesion.
  3. P. Carinii has been renamed P. jiroveci but the eponym PCP is retained (Emerg Infect Dis 2002;8:891
  4. Gross case of hairy leukoplakia on the lateral border of the tongue. It appears as a corrugated white keratotic lesion.
  5. Figure 14-36. Coccidioidomycosis. Coccidioides immitis infection presented with cough, fever, night sweats, weight loss, and a diffuse reticulonodular infiltrate on the chest radiograph. The presence of diffuse bilateral reticulonodular or nodular infiltrates is one of the most consistent findings in patients with AIDS and coccidioidomycosis. ( From Bronnimann et al. []; with permission.)
  6. The first regimen must be selected with the aim of suppressing the virus replication to the maximum achievable levels in the shortest time possible. It needs also to have the quality of durability by not inducing resistance early . Its side effects must be tolerable to the patient so that the quality of life is improved.
  7. HF =hepatic failure; RF = renal failure
  8. combination of TDF with ddI leads to unpredictable ddI levels and increased ddI toxicity
  9. HF =hepatic failure; RF = renal failure
  10. didanosine + abacavir + PI/ritonavir (ddI) (ABC) (LPV/r if NFV used)