Management of Specific HIV related Conditions

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Bacterial infections

In the HIV infected child infections are likely to be more frequent, of longer duration with a poorer response to treatment. Septicaemia, meningitis, pneumonia and abscesses frequently occur before any other features of HIV infection are evident. The causative organisms, however, are likely to be similar to those found in non-HIV-infected children and the standard guidelines on the choice of antibiotics apply. (However, in a child with severe pneumonia where Pneumocystis jiroveci pneumonia (PCP) is suspected, a course of high dose cotrimoxazole (60mg/kg every 8hrs) and steroids are indicated.

Once a child is diagnosed as having HIV-related pneumonia cotrimoxazole prophylaxis should be commenced:

Medicine	Paed Dose	Frequency	Duration
cotrimoxazole po	< 6mths = 120mg  6-12mths = 240mg >1 year = 480mg	once a day	for paediatric life

There is an increased risk of tuberculosis infection in the HIV infected child. Where TB is confirmed, or with a diagnosis of probable TB, use the anti-TB treatment regimens recommended in the Chapter on Tuberculosis.

Recurrent/ persistent diarrhoea

Current evidence suggests that no single pathogen is responsible for the persistence of episodes of diarrhoea (>14 days). Follow the diarrhoea management guidelines in the section on diarrhoea in main STG.

Chronic otitis media, oral candidiasis, eczema/papular rash, and anaemia

may be related to HIV infection but are managed according to standard guidelines.

Lymphocytic interstitial pneumonitis (LIP)

LIP is more commonly seen, presenting after the first year of life. Short term steroids have been used with good effect in children with severe respiratory symptoms. Give first dose of antibiotic (see management of pneumonia) and refer for specialist diagnosis. Child needs to be initiated on ART.