HIV/AIDS in Children

By ULY CLINIC Staff,

Management of HIV/AIDS in Children

Human immune deficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) is a disease of the human immune system caused by infection with human immunodeficiency virus (HIV).

This chapter focuses mainly on management of HIV in Infant and children

Diagnostic Criteria

Positive antibody test for HIV children >18 months of age.
Positive DNA PCR for HIV (indicated for children < 18months.
Presumptive Diagnostic of Severe HIV Disease in children under 18 months should be made if: HIV antibody-positive AND a Diagnostic of any AIDS-indicator condition(s) OR the child is symptomatic with two or more of the following: oral thrush, severe pneumonia, and severe sepsis.

Investigations

Antibody Tests for HIV- Bioline, Uni-Gold and ELISA.
DNA PCR for HIV (indicated for children < 18months).
CD4+/CD8+
Viral Load
FBP, Seum Creatinine, BUN, AST, ALT, Chest X Ray (For evaluation and monitoring of Anti Retro viral Therapy (ART).

Treatment

Pharmacological treatment

Table below shows Recommended First-Line ARV Therapy for under 15 years

Overview

Note:

For dosing of ARV regimens see Annex 4 Paediatric ARV Dosage

TDF may only be given to children > 2 years and above 35kg formulation. paediatric formulation is available but adolescents >40kg can take adult ATV/r can be used as an alternative to LPV/r in children above 6 years old if
All children failing second line ART require expertise review therefore follow referral procedure as stipulated in the National HIV/AIDS guideline

Table below shows Third line regimens paediatrics and adolescents

Give Cotrimoxazole PO 6 – 8 mg/kg TMP once daily to the following:

All exposed infants until HIV infection is excluded from 4-6 weeks of age.
All children<5year of age confirmed to be HIV infected regardless of symptoms or CD4%.
All HIV infected children >5years of age who are symptomatic (WHO Clinical stages 2, 3 or 4) or with a CD4 of < 350.

Table below shows recommended dosages of Cotrimoxazole prophylaxis

Prophylaxis for HIV Exposed Infants

Administer NVP syrup immediately after birth to all HIV exposed infants and Continue until six weeks of age

In case a high risk infant is identified, administer additional AZT syrup (twice daily) for the first 6 weeks of life

High-risk infants are those who are:

Born to women with established HIV infections who have received less than four weeks of ART at the time of delivery; OR
Born to women with established HIV infection with viral load >1000 copies/mL in the four weeks before delivery OR
Born to women with incident HIV infection during pregnancy or breast-feeding OR
Identified for the first time during the postpartum period, with or without a negative HIV test prenatally.

Infant prophylaxis is most effective when given immediately after birth preferably within 6 to 12 hours.

Table below shows Infant NVP dosing

Prophylaxis infants

Based on the dosing required to sustain exposure in the infant of >100 ng/mL with the fewest dose changes

Low birth weight infants <2000g should receive mg/kg dosing, suggested starting dose is 2mg/kg once daily.

Table below shows AZT dosing in Infants

Low birth weight infants (<2000g) should receive mg/kg dosing, suggested starting dose is 4mg/kg twice daily

Management of HIV-related conditions

The treatment of most infections (such as pneumonia, diarrhoea, meningitis) in HIV-infected children is the same as for other children. However, some HIVrelated conditions require specific management and these are described below.

Pneumocystis Jiroveci Pneumonia (PJP)

This is a serious infection that causes inflammation of the lungs. It's caused by a fungus called Pneumocystis Jiroveci, is the major cause of severe pneumonia and death in HIV infected infants.

Diagnostic Criteria

Marked respiratory distress (chest in drawing, cyanosis, inability to drink)
Severe persistent cyanosis/hypoxia (SPO2< 90%)

Investigations

Chest x-ray
Immunofluorescent stainsSilver or Sputum induction with nasopharyngeal aspirate stained with Giemsa or
Broncho alveolar lavage
ABG analysis

Treatment

Non Pharmacological Treatment
Oxygen therapy
Maintain adequate fluid and calorie intake

Pharmacological Treatment

High dose Cotrimoxazole (CTX) IV or PO 8mg/kg TMP-40mg/kg sulfamethoxazole given every 8 hours for 21 days
Prednisone at 1- 2mg/kg/day for 7-14 day (taper if given for more than 7 days)

Oral and oesophageal candidasis

Fungal infection of the mucosa lining of the oral cavity and oesophagus

Diagnostic Criteria

For oral candidiasis - white patches on the oral cavity
For oesophageal candidiasis - present with refusal to feed and crying during with white patches on the oral cavity extending to the oesophagus

Treatment

Non Pharmacological treatment

Clean the mouth at least 4 times a day, using clean water or salt solution and a clean cloth rolled into a wick.
Apply 0.25% or 0.5% gentian violet to any sores.

Pharmacological treatment

For oral candidiasis

Give Nystatin oral suspension 200,000 IU 6 hourly for 14 days. OR
Give 2% Miconazole oral gel, 5ml 12 hourly for 2 weeks.

For oesophageal candidiasis

Give Fluconazole PO 3 – 6 mg/kg once per day for 7 days. OR
Give Fluconazole IV 3 – 6 mg/kg once per day for 7 days.

Last updated on 16.09.2020

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References

Tanzanian Standard treatment guideline for children 2017 edition page 95- 10
WHO. Treatment of children living with HIV. https://www.who.int/hiv/topics/paediatric/en/. September 16.2020
WHO. HIV/AIDS. https://www.who.int/news-room/fact-sheets/detail/hiv-aids. September 16.2020

PCP management

Oral/esophageal candidiasis