MANAGEMENT OF HIV

Diagnosis of HIV infection in children

HIV serological assays:

<18 months of age used as a screening assay to determine HIV exposure >18 months of age used as a diagnostic assay
sensitivity of 99% specificity of 98%

HIV virological assays

used to diagnose HIV infection in infants and children less than 18 months of age.

HIV DNA on whole blood specimen or dried blood spots (DBS) HIV RNA on plasma or DBS ultrasensitive p24 antigen (Up24 Ag) on plasma or DBS sensitivity of 95% specificity of 98%

It is strongly recommended that well, HIV-exposed infants undergo HIV serological testing at around 9 months of age .Those who have reactive serological assays at 9 months should have a virological test to identify infected infants who need ART. Infants with signs or symptoms suggestive of HIV infection undergo HIV serological testing and, if positive (reactive), virological testing.

TREATMENT

ANTIRETROVIRAL THERAPY IN PREGNANCY

1.

ARV PROPHYLAXIS: A) MATERNAL AZT REGIMEN B) TRIPLE ARV PROPHYLAXIS REGIMEN from 14 wks gestation until 1 week after all exposure to breastmilk has ended

ART : STAGE 3, 4 OR CD4 COUNT < 350 cells/mm3 Continue thereafter

2.

Recommendations for initiating ART in infants and children

Recommendations for initiating ART in HIVinfected infants and children according to clinical stage and immunological markers

a Stabilize any opportunistic infection (OI) before initiating ART. b Baseline CD4 is useful for monitoring ART even if it is not required to initiate ART.

ARV DRUGS are broadly classified by the phase of the retrovirus life-cycle that the drug inhibits:

1. Non-nucleoside reverse transcriptase inhibitors

(NNRTI): Efavirenz ,Nevirapine 2. Nucleoside reverse transcriptase inhibitors (NRTI): Zidovudine, Didanosine ,Zalcitabine ,Stavudine ,L amivudine 3. Protease inhibitors : Ritonavir, indinavir 4. Entry inhibitors :Enfuvirtide 5. CCR5 receptor antagonists 6. Integrase inhibitors: Raltegravir

RECOMMENDED FIRST-LINE ARV REGIMENS FOR INFANTS AND CHILDREN

< 24 months

1. Not exposed to ARVs: ART with nevirapine (NVP) + 2 nucleoside reverse transcriptase inhibitors (NRTIs).
2. Exposed to maternal or infant NVP or other NNRTIs used for maternal treatment: ART with lopinavir/ritonavir (LPV/r) + 2 NRTIs.

For children more than 24 months and less than 3 years of age : ART with NVP + 2 NRTIs.

For children 3 years of age and above: ART with an NVP or efavirenz (EFV)-containing regimen + 2 NRTIs.

ARV DRUG TOXICITY

Toxicity event Severe anemia or neutropenia Lactic acidosis Severe gastrointestinal intolerance Responsible ARV ZIDOVUDINE

Lactic acidosis Peripheral neuropathy Pancreatitis

Acute symptomatic hepatitis Hypersensitivity reaction Persistent and severe central nervous system toxicity Potential teratogenicity

STAVUDINE

NEVIRAPINE EFAVIRENZ

After failure on a first-line NNRTI-based regimen, a boosted PI plus 2 NRTIs are recommended for second-line ART.

THANK YOU