General Notes for HIV Infection in Children

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Paediatric HIV infection can be significantly reduced by implementing an effective Prevention of Mother to Child Transmission (PMTCT) program. Symptomatic HIV infection may be difficult to distinguish from other childhood conditions such as respiratory infections, diarrhoea and malnutrition. Suspect HIV related disease if two or more of the following signs are present:

  • severe or recurrent pneumonia
  • generalised lymphadenopathy
  • hepato-splenomegaly
  • failure to thrive
  • severe/recurrent oro-pharyngeal
  • finger clubbing

In the majority of cases, the route of transmission is from mother to child. Ensure pre-test counselling of parents/caregivers before testing the child for HIV infection. Antibody detection tests are not diagnostic of true infection before 18 months due to persistence of maternal antibodies in the child.

General Guidelines for HIV care in children

Nutrition: advise the caregiver on high calorie diet and other essential nutrients for the child. Safe food and water practices

Hydration: oral rehydration, together with dietary advice is most important in the management of persistent diarrhoea. Intravenous fluids may be needed during severe diarrhoeal episodes.

Immunisation: BCG should be given to all children at birth. Immunisation is contraindicated only where there is symptomatic HIV infection. The current recommendation is to give the other live vaccines, measles and oral poliomyelitis vaccine even in immune­ compromised children. [See chapter on Immunisation in main STG.]

Home care: is preferable to hospital admission for chronic care.

Counselling: the family will require support in facing the emotional and financial demands of the child's chronic ill health as well as those arising from the parents' own HIV status. Facilitate access to OI clinics.