SN1
SHORT NOTE
5M
★ High-yield
Define HIV Infection in Children. Describe its clinical features, diagnosis and management.
Definition & Transmission
- Paediatric HIV is infection with the human immunodeficiency virus, causing progressive immunodeficiency.
- In children the commonest route is vertical (mother-to-child) transmission — intrauterine, intrapartum, or through breastfeeding; also via infected blood/products.
Clinical Features
- Failure to thrive, recurrent/severe or unusual infections, chronic diarrhoea, persistent oral thrush.
- Generalised lymphadenopathy, hepatosplenomegaly, parotid enlargement, developmental delay.
- Opportunistic infections (e.g. Pneumocystis pneumonia, TB); WHO clinical staging I–IV.
Diagnosis
- Under 18 months — a virological (HIV DNA/RNA PCR) test is required, because maternal antibody persists and antibody tests can be falsely positive.
- Over 18 months — HIV antibody testing (as in adults).
Management & Prevention
- Antiretroviral therapy (ART) for all diagnosed children (combination regimen), with adherence support.
- Co-trimoxazole prophylaxis against opportunistic infection; routine and additional immunisation; nutrition; treat infections/TB.
- Prevention of mother-to-child transmission (PMTCT) — maternal ART, safe delivery, infant ARV prophylaxis and safe infant-feeding counselling.
WHO Clinical Staging (overview)
- Stage 1 — asymptomatic/persistent generalised lymphadenopathy.
- Stage 2 — recurrent respiratory infections, skin conditions.
- Stage 3 — moderate (chronic diarrhoea, oral thrush, TB).
- Stage 4 — severe (AIDS-defining: PCP, severe wasting, malignancy).
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