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MANAGEMENT OF HIV INFECTION IN CHILDREN Recommendation on prophylaxis using co-trimoxazole Prophylaxis for an HIV infected child should be guided by age, WHO staging and CD4 % (Grade C) Cotrimoxazole dosage - • 4mg TMP/20mg SMX /kg daily (Grade B) OR • 150 mg TMP/ 750 SMX mg/m2 /day divided twice daily for 3 days per week (Grade B) Alternative to co-trimoxazole Dapsone (2mg /kg daily ) (Grade B) OR Aerosolized pentamidine • Children 5 years of age and older - 300 mg once every four weeks (Grade C) • Children less than 5 years of age- either 120 mg once monthly or 60 mg every 2 weeks, after a 4 week period of induction therapy at 60 mg/week (Grade B) Please refer to Appendix 6 for details of investigations for opportunistic infections. 5. NON INFECTIOUS COMPLICATIONS OF HIV In addition to secondary infections, health care personnel managing HIV infected children should be vigilant of the non-infectious complications of HIV. 5.1 MALIGNANCY There is an increased incidence of malignant disease in children with vertically acquired HIV infection. 227, Level 8 However, the number of children with HIV infection who develop a malignancy is poorly defined. The tumours seen in HIV infected children are somewhat different than those in adults and the spectrum appears to be age-dependent. Non-Hodgkin lymphoma is the most common cancer in HIV infected children. Other significant malignancies occurring in children withAIDS are Kaposi sarcoma, Hodgkin disease, 227, Level 8; 228, Level 8 primary brain lymphomas and leiomyosarcoma. 5.2 NEUROLOGIC COMPLICATIONS Non-infectious neurologic manifestations of AIDS were reported to occur among 10% of patients less than 18 years of age. 229, Level 8 They presented with a variety of neurological manifestations including focal motor signs, altered tonus, retarded neurodevelopment, cognitive disturbances, intractable headache, seizures, and coma. The study showed that the mean age of presentation amongst vertically transmitted children was 5.8 years (range, 2-11 years). 47
5.3 HIV-ASSOCIATED NEPHROPATHY Strauss reported that 8% of 155 children with AIDS developed HIV-associated nephropathy (HIVAN) They presented with persistent proteinuria, azotemia, 230, Level 8 haematuria, renal tubular acidosis, and end-stage renal disease. Focal segmental glomerulosclerosis (FSGS) is the predominant glomerular lesion in HIVAN. Other reported glomerular lesions in patients with HIV 230, Level 8 ;231, Level 8 include IgA nephropathy and cryoglobulinemia. 5.4 CARDIAC COMPLICATIONS HIV infected children developed cardiac complications ranging from clinically silent lesions to fatal disease. 232, Level 8 The reported complications include left ventricular dysfunction, cardiomegaly and pericardial effusion. Cardiac dysfunction 233, Level 8 is independent risk factor for mortality in HIV infected children. 5.5 LYMPHOCYTIC INTERSTITIAL PNEUMONITIS (LIP) A study of HIV infected children with chronic lung disease showed that 234, Level 8 almost 60% of the patients had lymphocytic interstitial pneumonitis. Up to a third of all HIV infected children develop LIP and this usually presents in the 2nd or 3rd year of life. Affected children tend to have a better prognosis than children without LIP but secondary bacterial pneumonias and eventual bronchiectasis are common. LIP is classified as non-AIDS and Stage 3 (WHO Classification). Clinical features that are often associated with LIP include generalised and symmetrical lymphadenopathy, bilateral chronic non-tender parotid swelling, digital clubbing and hepatomegaly. Typical radiographic findings are diffuse bilateral reticulonodular infiltrates. ART improves symptoms and radiographic appearances of LIP and resolution of LIP has been reported among adults 235, Level 9; 236, Level 9 receiving HAART 6. OTHER ISSUES 6.1 DISCLOSURE MANAGEMENT OF HIV INFECTION IN CHILDREN Perinatally acquired HIV infection has become a chronic illness due to advances in medical treatment. As an increasing number of children infected with HIV live to older ages, the question of disclosure of the diagnosis (to the child and others) becomes more crucial. This maybe particularly challenging when children reach school going age. Their psychosocial needs are also changing to more closely resemble the needs of the chronically ill individual, rather than the terminally ill. Disclosure of the child's HIV diagnosis is controversial and an emotionally laden issue. The importance of disclosure relates directly to medication adherence, treatment compliance, child's developing autonomy and avoids potential transmission to sexual partners. 48
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This Guideline is intended a guide
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MANAGEMENT OF HIV INFECTION IN CHIL
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MANAGEMENT OF HIV INFECTION IN CHIL
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REVIEW COMMITTEE The draft guidelin
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3.30 MB - Academy of Medicine of Malaysia

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