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PAEDIATRIC AIDS

PAEDIATRIC AIDS. ¨ Acquired immunodeficiency Syndrome (AIDS) is caused by Human Immunodeficiency Virus type 1 and 2 ¨ World wide problem, more so in developing Countries.

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PAEDIATRIC AIDS

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  1. PAEDIATRIC AIDS • ¨Acquired immunodeficiency Syndrome (AIDS) is caused by Human Immunodeficiency Virus type 1 and 2 ¨World wide problem, more so in developing Countries. ¨Ever since the report of the first pediatric case in 1983, there has been an alarming increase in the incidence of disease • ¨WHO estimate of about 5 to 10 million children expected to be infected by the end of year 2000AD worldwide.

  2. PAEDIATRIC AIDS HIV infection occurs by contact with infected cells in blood and body fluids. T The predominant cells infected are CD4+ T lymphocytes, depletion of which causes immunodeficiency.

  3. PAEDIATRIC AIDS ¨EPIDEMIOLOGY ¨Pediatric AIDS constitutes 2% of all HIV infected cases in developed countries as compared to 15-20% in developing countries ¨In India, women and children constitute 50% of all HIV infected individuals ¨The pediatric population at risk for HIV-1 infection are; Øbabies born to infected mothers,

  4. PAEDIATRIC AIDS ¨Øchildren given HIV-1 contaminated blood or blood products, Øadolescents who acquire infection sexually or by use of intravenous drugs ¨The rate of mother to child transmission (vertical) of HIV-1 evaluated epidemiolocally in several surveys, has varied from 13-42%, with 65% of newborns infected during last six weeks of pregnancy and at delivery. ,

  5. PAEDIATRIC AIDS ¨¨Postnatal transmission via breast feeding has been found to be 14%. ¨In developing nations, the HIV-1 epidemic begun to reverse the gains in infant and childhood morbidity and mortality, previously realized through nutrition and vaccine programmes . ,

  6. PAEDIATRIC AIDS ¨¨ VERTICAL TRANSMISSION OF HIV-1 ¨It is an important and unique aspect of pediatric AIDS ¨HIV-1 may be transmitted to the infant during gestation (in utero), during delivery (intrapartum) or postpartum, through breast feeding. ,

  7. PAEDIATRIC AIDS ¨¨ ¨¨Factors which may increase rate of vertical transmission of HIV-1 are;- • 1.High viral load in the maternal circulation, • 2.Maternal seroconversion just before delivery, • 3.Vitamin A deficiency in mother, • 4.Vaginal delivery, • 5.Delivery before 34 weeks, • 6.Detectable p24 antigen in maternal serum, • 7.Absence of neutralizing antibodies in maternal serum,

  8. PAEDIATRIC AIDS ¨¨ 8.Maternal CD4 count less than 700/cmm or the CD4 + CD8+ ratio less than 0.6

  9. PAEDIATRIC AIDS ¨¨ ETIOPATHOGENESIS ¨HIV genome is single stranded RNA virus, 9.8 kb in size ¨

  10. PAEDIATRIC AIDS ¨HIV selectively binds to cells expressing CD4 molecule on their surface-primarily T4 lymphocytes (CD4+ cells) ¨Acts by REVERSE TRANSCRIPTASE ¨Cause intense viremia ¨Following cellular and humoral response within 1 week to 3 months, viral load decreases- PHASE OF CLINICAL LATENCY ¨Patient undergo gradual deterioration of immune system with depletion of CD4+ cells ¨More prone for opportunistic infections ¨

  11. PAEDIATRIC AIDS ¨CLINICAL FEATURES ¨Pattern of disease expression and progression is quite variable in HIV-1 infected children. ¨20-30 percent develop profound immunodeficiency and AIDS defining illnesses before the first year of life and two thirds having more slowly progressive course from 5 to 10 years. ¨Age of onset of any sign of HIV-1 infection predicts length of survival. ¨

  12. PAEDIATRIC AIDS ¨Clinical manifestations are the result of multi-system involvement associated with chronic persistent viral infection and secondary immunodeficiency. ¨Failure to thrive, unexplained persistent fever,hepatosplenomegaly, parotitis, persistent & invasive oral thrush, recurrent gastroenteritis, otitis media, lymphadenopathy are the common early and mild signs and symptoms. ¨

  13. PAEDIATRIC AIDS ¨¨LIP-lymphoid intertial pneumonia, organ specific infections and dysfunctions, repeated severe bacterial infections, loss of developmental milestones, meningitis, encephalopathy, idiopathic thrombocytopenia are commonly seen. ¨Any prolonged unexplained illness should raise a suspicion of HIV-1 infection ¨

  14. PAEDIATRIC AIDS ¨¨OPPORTUNISTIC INFECTIONS ¨Occur as CD4+ count declines. ¨PNEUMOCYSTIS CARINII (PCP) is the most common and lethal opportunistic infection in pediatric population. ¨ORAL CANDIDIASIS is the most common fungal infection, may involve oesophagus-vomiting,fever,dysphagia and anorexia ¨

  15. PAEDIATRIC AIDS ¨¨INTERSTITIAL CRYPTOSPORIDIOSIS –severe chronic diarrhoea and malnutrition ¨ATYPICAL MYCOBACTRIAL INFECTION with Mycobacterium avium intracellulare complex(MAC) ¨TOXOPLASMA GONDII, ¨HERPES SIMPLEX,VARICELLA ZOSTER, CMV,MEASLES ¨

  16. DIAGNOSIS OF HIV - 1 INFECTION IN CHILDREN PAEDIATRIC AIDSDIAGNOSIS OF HIV-1 INFECTION IN CHILDREN ¨¨¨ ¨

  17. DIAGNOSIS OF HIV - 1 INFECTION IN CHILDREN PAEDIATRIC AIDSDIAGNOSIS OF HIV-1 INFECTION IN CHILDREN ¨¨¨ ¨

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