Multi- disciplinary approach in Paediatric HIV
DR Priyantha J Perera Department of Paediatrics Faculty of Medicine, Ragama
Current situation ∗ Nearly 1500 new Paediatric infections occur daily ∗ 71 cases up to now in SL ∗ More than 90% of this is from the developing world and most due to MTCT ∗ HIV-infected infants frequently present with clinical symptoms in the first year of life ∗ Without ART one-third of infected infants are dead by one year and about half dead by 2 years
Change in the trend ∗ With ART, HIV-infected infants and children now survive to adolescence and adulthood ∗ Are we ready to face the challenges involved in providing a holistic care to these children.
Diagnosing Paediatric HIV ∗ Venepuncture hurts, plan your investigations and minimize the number of pricks ∗ Neonates have a limited blood volume – take only minimal volume required and avoid repeating investigations
Treatment of Paediatric HIV ∗ If ART is started before their immune system is badly affected, CD4 levels recover quickly. ∗ Children with lower the viral load by one year of age, tend to have lower viral load when they are 8-20 years old.
Issues Related to Treatment of Paediatric HIV ∗ ∗ ∗ ∗ ∗
Compliance is a major issue Small children cannot swallow tablets and capsules Children hate medicine – ARTs usually don’t taste nice Medicines often go OS??????? fixed-dose combination drugs not available for children ∗ Dose is calculated according to body weight- so increase the dose as they grow
Managing Paediatric HIV ∗ Apart from difficulties involved in diagnosing and initiating ART, managing Paediatric HIV is different to managing an adult with HIV ∗ Why?????? ∗ Because children are different. They are not just a half of an adult
Why children are different? ∗ ∗ ∗ ∗ ∗ ∗ ∗
Their nutritional requirements different They are growing They are learning More vulnerable to infections Immunizations They ask questions Emotionally unstable
Nutrition ∗ Breast milk the best food during first six months not recommended when mother is HIV positive ∗ Correct and safe preparation of formula milk is important ∗ There is a risk of overfeeding with formula milkk ∗ Gastro-enteritis in these children is more likely and more damaging in these children
Nutrition ∗ Asymptomatic children living with HIV need 10% more calories ∗ symptomatic Children and those who are recovering from infections, 20-30% more calories than other children ∗ All ARTs supress the appetite. ∗ Recurrent infections supress the appetite
Nutrition ∗ On the other hand with the risk of metabolic syndrome later type of diet need careful selection ∗ Decreased bone density observed in these children warrant diets with more calcium and vitamin D
Growth ∗ HIV-infected children grow considerably slower, and differences between infected and uninfected children increased with age. ∗ This is due to both limited intake and increase demand ∗ Growth needs close monitoring ∗ Issues of growth charts
Neuro-development ∗ Does HIV infection effect neurodevelopment of children ∗ Does ART effect neurodevelopment of children ∗ Adverse socio-economic condition do effect ∗ Bringing children in a simulative environment is vital for optimum neurodevelopment
Immunization ∗ ∗ ∗ ∗ ∗ ∗ ∗ ∗
BCG Hepatitis B Pentavalent OPV Live JE MMR Chicken pox Pneumococcal
Disclosure ∗ ∗ ∗ ∗ ∗
They will want to know what is wrong with them Why should I take daily medicine when I am not ill What are you going to tell When are you going to tell Who is going to tell
Issues related to schooling and adoption ∗ Ideally brought up in a family environment ∗ Adoption, how feasible? ∗ Should they attend normal school
Summery ∗ Managing a child with HIV is not merely making an early diagnosis and starting ART ∗ There are many special issues to specific to children ∗ Need a multidisciplinary approach to acehive optimum care