Resumo de Hiv Infection In Children

infection caused by hiv 1 and hiv 2
hiv epidemiology
total number of people living with hiv 40.3 million
new hiv infection in 2005 4.9 million
deaths due to aids in 2005 3.1 million

current scenerio
there are about 14000 cases reported every day in 2005
more than 95% of those were in low and middle income countries
almost 2000 were children under fifteen years
about 12000 were persons aged 15-49 years
-of whom almost 50% were women
about 50% were 15- 24 years old
india
has 5.2 million infections by 2005
maximum transmission by heterosexual contact [86%]
male femal ratio3:1
hiv sub type c is most prevalent
routes of transmission
inutero
during delivery
brest feeding
other routes
natural history
rapid progressors
20% develop aids and die in first 12 months,majority by 4 months of age
present as severe failure to thrive,pcp pneumonia,encephlopathy and oesophageal candidasis
slow progressors
8% annual incidence of progression to aids,median age of diagnosis at 4 years
overall median survival time 8-10 years
common manifestations lymphoid interstitial pneumonia,recuurent bacterial infection ,tuberculosis,malignancies
effect on immune system
by measuring cd 4 count as percentage

> 25% :normal
15-24%:moderate suppression,repeat in 3-6 months
<15% :begin treatment[<20% in infants less than 18 months of age
diagnosis
below 18 months hiv rna,hiv dna pcr,hiv culture.p 24
after 18 months,elisa,western blot,hiv dna pcr,hiv rna
treatment
anti retoviral therapy- consists of nucleoside inhibitors[zidovudine],non nucleoside inhibitors[nevirapine] and protease inhibitors[lopinavir]
three drugs are used as 10 billion copies of virus made every day,reverse transcriptase is working so hard and fast it makes a lot of mistakes.1-2 mutations appear in the virus each replication cycle.half of the virus in plasma is cleared and replaced each day

prevention
vertical transmission[mother to child]
with out intervention
16-25% in north america and europe
30-40% in india
after single drug therapy
11-13% transmission
with effective maternal ARV therapy,ceasearian, exclusive formula feeding
<2%
care for hiv infected pregnant women
antenatal check up with hiv screening
evaluate degree of immune deficiency -cd 4 count
if cd 4<200 treatment is indicated

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