90% of the 1.8 million global cases of paediatric HIV are in Sub-Saharan Africa
Pathophysiology
Mother to child transmission (MTCT)
- Without intervention, between 15-45% of babies born to HIV-infected mothers are infected
- Transmission can occur during pregnancy, delivery, and breastfeeding
- Transmission can be reduced to less than 1% with intervention
- Maternal lifelong antiretroviral treatment, aiming for undetectable viral load in mum
- Screen and treat for other STDs, especially herpes
- Infant prophlaxis with co-trimoxazole for 6 weeks
- Child shoud be tested at birth, 6 weeks, 9 months, 18 months, then 6 weeks after cessation of breastfeeding
Clinical presentation
- Recurrent or severe common childhood illnesses e.g. otitis media, diarrhoea
- Recurrent oral candidiasis not responding to treatment
- Recurrent severe bacterial infections e.g. meningitis
- Failure to thrive or growth failure
- Generalised lymphadenopathy, hepatosplenomegaly
- Other conditions suggesting immunosuppression - PJP, Kaposi sacroma, TB, lymphocytic interstitial pneumonia etc.
Investigations
Testing
- Counselling/testing should be offered to:
- All in countries with generalised HIV epidemis
- All exposed infants at birth
- Any infant child with any suspicion of HIV
- <18 months of age - virological PCR for HIV DNA or RNA
- >18 months - serological rapid antibody test
Staging
- Immunological staging - CD4+ count
- Virological staging - viral load
Management
- Since 2015, WHO recommend treatment for all children living with HIV, regardless of clinical stage
- HAART - two NRTIs plus one NNRTI or protease inhibitor
- NRTI - nucleoside reverse transcriptase inhibitors e.g. abacavir
- NNRTI - non-nucleoside reverse transcriptase inhibitor e.g. efavirenz
- Protease inhibitor e.g. kaletra
- Complications of treatment:
- Compliance and side-effects
- Immune reconstitution inflammatory system (IRDS) - milder manifestations can be managed with NSAIDs
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