Hiv Infection In Children
(DR JAYAPRAKASH K P)
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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