HIV AND AIDS IN

CHILDREN

BY; MR FWALANGA STUDENT TUTOR

GENERAL OBJECTIVE

•At the end of the lesson Students should be able to acquire knowledge
and demonstrate an understanding of HIV and AIDS in children.
SPECIFIC OBJECTIVES
At the end of the lesson students should be able to:
1.Definition of terms
2.State the mode of transmission of HIV to children.
3.Explain the diagnosis of HIV in children.
4.Identify children in need of DBS.
 SPECIFIC OBJECTIVES

4. Outline the collection of DBS samples.

5. State the WHO staging of HIV in children.
6. Outline the clinical course of HIV infection in
children.
 INTRODUCTION
Today will be discussing HIV and AIDS in children.
Human immunodeficiency virus (HIV) is the virus that
is responsible for causing acquired immune deficiency
syndrome (AIDS). The virus impairs cells of the
immune system and progressively destroys the ability
of the body to fight the infection in adults and
adolescents.
 Definitions
• AIDS- Acquired Immunodeficiency syndrome (WHO)

• HIV- Human Immunodeficiency Virus (WHO)

• Immunodeficiency- is a state in which the immune

system’s ability to fight infectious disease is
compromised or entirely absent. (WHO)
 Definitions cont..
• Viral load- A measure of the number of viral
particles present in an organism or environment,
especially the number of HIV viruses in the
bloodstream. (WHO)
• CD4 count- is the test that measures how many
CD4 cells you have in your blood. These are a type
of white blood cell, called T-cells, that move
throughout your body to find and destroy bacteria,
viruses, and other invading germs. (WHO)
 Definitions cont..
• Drug resistance-is the reduction in
effectiveness of a medication such as an
antimicrobial or an antineoplastic in curing a
disease or condition. (WHO)
 Mode of transmission of HIV to children

• Most children get the virus from their infected

mother during delivery when exposed to infectious
blood and body fluids
• Through breastfeeding especially when the mother
has cracked nipples and the baby has oral thrush
• During pregnancy the fetus can get infected by HIV
crossing the placenta
Mode of transmission of HIV to children
• Blood transfusion
• Organ transplant
• Sexual intercourse.
 Diagnosis of HIV in children
 children (0 to <10 years old)
• Well, never-breastfed HIV Exposed Infant (HEI)
At birth/first week of life or at first contact a
nucleic acid test (NAT) is done which is repeated
at 6 weeks old,
• At 18 months old a Serologic test is done
 Diagnosis of HIV in children cont…
Well, breastfed HEI
• At birth/first week of life or at first contact
nucleic acid test (NAT) is done which is repeated
when the child is 6 weeks old and at 6 months
old.
• At 9 months old a Serologic test is done. If the
child is found to be positive, follow with NAT. If
negative, follow up with serologic test at 18
months
 Diagnosis of HIV in children cont…
• At 12 months old Serologic test, if positive, follow
with NAT. If negative, follow up with serologic test
at 18 months
• 18 months old Serologic test; if positive, follow up
with NAT
• 24 months old Serologic test, if positive, follow up
with NAT
 Diagnosis of HIV in children cont…
 Infant or child who has completely stopped
breastfeeding
• ≥6 weeks after breastfeeding cessation
Serologic test should be done; if positive,
follow up with NAT
• ≥18 months old Serologic test
 Diagnosis of HIV in children cont…
 Asymptomatic infant with unknown HIV
exposure
- At first contact, a Maternal serologic test and
infant serologic testis done which is followed by
performing a NAT for positive serologic child <18
months old.
 Diagnosis of HIV in children cont…

 Infant or child symptomatic for HIV infection

• Immediately regardless of age Serologic test; follow
with NAT for positive serologic
 Diagnosis of HIV in children cont…
Positive serologic child <18 months old
At first contact
• For all infants and children with unknown HIV status
admitted for inpatient care, attending malnutrition
clinic, outpatient care or immunization clinics, an
Age-appropriate Routine HIV tests is done.
 Diagnosis of HIV in children cont…
 Adolescents (10 – 19 years) and adults
• All sexually active persons with their partners
and any person of unknown HIV status
• At first contact, 3 months if negative and every
6 months
• Serologic test is performed.
 Diagnosis of HIV in children cont…
• Note: Where there is no POC NAT a DBS should be
sent for HIV PCR. Where NAT is positive, a repeat
test should be done to rule out false-positive results.

• cART should be initiated without waiting for the

receipt of the second test result because of the high
risk of mortality with in utero infection;
 Diagnosis of HIV in children cont…
• if the second specimen tests negative, a third NAT
should be performed before interrupting cART.

• Although plasma remains the gold standard

sample for NAT, DBS will be the preferred mode
of sample transportation for both DNA and RNA
testing.
 children in need of DBS (Dried Blood Spot)
Two types of infants who will need HIV diagnostic
testing
• Infants who are HIV- exposed (mother known HIV
positive from ICTC)
• Infants who are sick with signs and symptoms of HIV,
even if unknown HIV exposure status.
 Collection of DBS samples
DBS Collection Procedure
• Choosing the location to draw blood is important in
preparing a DBS sample. If the area does not bleed
sufficiently, the sample may be too small to test.

• children 1-4 months old and weighing less than 6 kg,

collect from the Heel
• 5-10 months, weighing less than 10 kg Toe
• Larger than 10 kg Finger
 Collection of DBS samples cont…
• After choosing the location, proceed to Warm the
the chosen area to facilitate blood flow. This can be
done by wrapping a hand around the foot while the
baby sits in its mother’s lap.

• Then Position the baby with its feet down.

• Clean the baby’s foot with disinfectant and let it dry.
 Collection of DBS samples cont…

• While wearing gloves free of powder, then

pricks the baby’s foot with a lancet to draw
blood.
• The first drop of blood should be wiped away
with gauze or cotton wool.
 Collection of DBS samples cont…
• Then allow a large drop of blood to collect on the
foot before touching it to the circle on the filter
paper. The circle should be filled completely by the
blood drop and at least two circles should be filled
per card.
• The foot should then be cleaned with disinfectant
and left unbandaged.
Collection of DBS samples cont…
Collection of DBS samples cont…

…
Collection of DBS samples cont…
 Clinical Staging of Pediatrics HIV Infection
• WHO clinically classifies HIV in children into four
stages (1, 2, 3 and 4) representing progressively
more severe disease and worsening prognosis.
• Stage 1is the asymptomatic stage
• Stage 2 is the mild stage the child presents with
symptoms like Fungal nail infections, Recurrent oral
ulcerations, Lineal gingival erythema, Angular
cheilitis, Parotid enlargement, Herpes zoster etc.
Clinical Staging of Pediatrics HIV Infection cont..

• Stage 3 is the advanced stage characterized by

Moderate unexplained malnutrition, not adequately
responding to standard therapy Unexplained persistent
diarrhoea (14 days or more).
Clinical Staging of Pediatrics HIV Infection cont..
• Stage 4 is the severe stage there during this
stage, there are many complications that
develop such as;
• unexplained severe wasting or malnutrition not
responding to standard therapy,
• Pneumocystis pneumonia,
• Recurrent severe bacterial infections
(empyema, pyomyositis, bone or joint
infections, meningitis)
Clinical Staging of Pediatrics HIV Infection cont..
• Category 1 (25 – 30%): Rapid progression
• Rapid disease progression; infants die within 1
year. Disease acquired in-utero or perinatally.
• Category 2 (50 – 60%): Slow progression
• Children who develop symptoms early in life.
Deteriorate and die by 3 to 5 years.
• Category 3 (5 – 25%): Long-term survivors
Long-term survivors who live beyond 8 years of age
Clinical Staging of Pediatrics HIV Infection cont..
• There are some factors that are related to
disease progression and these are:
• Size of infecting viral dose which is dependent
on maternal disease status.
• The child’s immature immune system limits
ability to contain the virus.
• Low infant CD4+ cell counts/percentages.
Infants with high peak viral load have more
rapid progression
 Clinical course of HIV infection in children

Clinical presentation of slow progressors

• Opportunistic Infections after 2 - 10 years
• Growth stunting common
• Lymphoid interstitial pneumonitis (LIP)
• Parotitis
• Recurrent bacterial and fungal infections
Clinical course of HIV infection in children cont…
• Skin problems
• AIDS related cancers
• Low viral loads at birth, stable CD4 counts for 2
- 10 years then slow decline
Thank you