HIV AND AIDS IN CHILDREN

 Description

Human Immunodeficiency Virus (HIV) is a retrovirus that attacks the body’s immune system, primarily CD4 T-lymphocytes. Untreated HIV can progress to Acquired Immunodeficiency Syndrome (AIDS), characterized by profound immunosuppression, severe organ damage, opportunistic infections, and malignancies.

Paediatric HIV transmission:

• Vertical (mother-to-child): In utero, intrapartum, or through breastfeeding — the most common mode in Zambia.

• Horizontal: Sexual transmission (e.g., rape, defilement, high-risk survival sex) or parenteral exposures (rare in children).

Pathophysiology:

• HIV infects CD4+ T cells, macrophages, and dendritic cells.

• Progressive CD4 depletion impairs cell-mediated immunity, increasing susceptibility to bacterial, viral, fungal, and protozoal infections.

• Chronic inflammation contributes to end-organ damage, growth failure, and neurodevelopmental delays in children.

 Signs and Symptoms

Clinical manifestations of HIV in children are stage-dependent (WHO clinical staging, Zambia). Symptoms include:

Other signs:

• Delayed milestones in infants

• Failure to thrive

• Recurrent bacterial infections

• Neurological impairment (HIV encephalopathy)

 Investigations

Entry point to HIV care:

• HIV Testing Services (HTS): Should be offered to all children attending any health facility in Zambia (public and private).

• Positive test: Link immediately to care and treatment.

• Negative test: Link to combination HIV prevention services.

Laboratory investigations:

• Confirmatory HIV testing: PCR for children <18 months, rapid antibody tests for >18 months.

• CD4 count / percentage: Assess immune status.

• Viral load: Monitor ART effectiveness.

• Baseline labs: CBC, LFTs, renal function, hepatitis B/C testing.

• Screen for opportunistic infections: TB testing, cryptococcal antigen, CMV, toxoplasmosis if indicated.

• Growth and nutritional assessment: Weight, height, head circumference, BMI-for-age.

 Antiretroviral Therapy (ART) in Children

Refer to: Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection (ZCGs).

Key principles:

• Early ART initiation: All children diagnosed with HIV should start ART regardless of clinical stage or CD4 count.

• Preferred regimens: Weight- and age-based combinations, e.g., integrase inhibitor-based regimens for children ≥4 weeks and ≥3 kg.

• Monitoring:

  • Clinical: Growth, development, opportunistic infections

  • Laboratory: Viral load at 6 months after ART initiation, then every 12 months if suppressed

 Supportive Care

• Nutritional support: High-calorie diet, micronutrient supplementation, manage malnutrition

• Prevention of opportunistic infections: Cotrimoxazole prophylaxis for bacterial infections and Pneumocystis jirovecii

• Vaccinations: Maintain routine immunizations; some live vaccines may be contraindicated in severe immunosuppression

• Psychosocial support: Disclosure counseling, caregiver education, adherence support

 Prevention of Mother-to-Child Transmission (PMTCT)

• Antenatal ART for HIV-positive mothers

• Safe delivery practices

• Infant prophylaxis: Nevirapine or zidovudine for newborns

• Exclusive breastfeeding with maternal ART

 Summary

• HIV is a retrovirus targeting CD4+ T cells; untreated, it can progress to AIDS.

• Vertical transmission is the most common cause in children.

• Clinical staging guides severity assessment and management.

• HTS is the entry point to care; ART initiation is essential in all confirmed cases.

• Supportive care, nutritional optimization, prophylaxis, and psychosocial support are crucial.

• Adherence and regular monitoring improve long-term outcomes.