Monday, December 4, 2017

HIV Disease in Children


Resident’s Name: Carol Caudill                                                                                 Date: 12/06/2017
Article Title: HIV disease in children: The many ways it differs from the disease in adult
Author(s): Joseph A. Church
Journal: Journal of Postgraduate Medicine
Date: April 2000
Major Topic: HIV in children
Type of Article: background information
Main Purpose: To discuss differences in how AIDS presents in children compared to adults
Key Points:  Children are more prone to recurrent infections than adults. They also have to take more medication per body weight and have more nutrient requirements.

·      Pediatric and adult HIV infection and AIDS differ significantly in definition, epidemiology and transmission, diagnostic challenges, pathogenesis, clinical manifestations, and management

Definition
·      A CD4+ T cell count of less than 200/mm3 of blood is considered AIDS in children over 13 and adults; however, in young children there’s no number to define AIDS
·      Classification in children is done by signs/symptoms and by immunologic category
·      They are classified by their worst state, not their current state. Category 3 is considered AIDS

     

Epidemiology and Transmission
·      Most children who have HIV get it through perinatal transmission from mother to newborn
·      The number of babies born with HIV infection has decreased due to public health efforts to identify HIV-infected pregnant women, avoidance of breast-feeding by HIV-positive women, effective anti-retroviral therapy of infected women, and postnatal prophylaxis of their newborn infants
·      Elective cesarean section has also been shown to reduce risk of maternal-infant HIV transmission

Diagnostic challenges
·      Almost all infants born to HIV-positive women have positive results for HIV antibodies because of maternal IgG that has crossed the placenta. However, only 20% of infants acquire HIV even without antiretroviral therapy
·      For a child of less than 18 months to be considered HIV-positive, they must have positive test results on at least two separate occasions on HIV cultures, HIV PCR, or HIV p24 assays.

Pathogenesis
·      In children, HIV replicates in numbers much higher than in adults due to their immature, highly active, developing immune system
·      The nervous system in children is also susceptible to HIV and can lead to neuromotor and cognitive delay and regression

Clinical manifestations
·      HIV disease in children is very variable in the time of symptom onset
·      B-cell dysfunction leads to severe recurrent infections like otitis media, sinusitis, and pneumonia. Children also experience failure to grow normally and delayed puberty

Management
·      Control of HIV replications is the goal of treatment in both children and adults
·      Young children usually require substantially more medication per unit of body weight than does a typical adult
·      Preventing secondary infections is important. Live virus vaccines should be avoided until immunologic status is okay
·      Children have greater caloric and micronutrient requirements for their size than adults do
·      Social support is important
Remarks:
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Assessment of Article:  Level of Evidence/Comments: Level III

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