Post on 14-Jun-2015
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Pediatric HIV/AIDSPediatric HIV/AIDS
Nikki DiekerNikki Dieker
AIDS StatisticsAIDS Statistics
Today 40 million people are estimated to be Today 40 million people are estimated to be living with HIV/AIDS including 3 million living with HIV/AIDS including 3 million childrenchildren
During 2001, AIDS caused the deaths of During 2001, AIDS caused the deaths of roughly 3 million people including 580,000 roughly 3 million people including 580,000 childrenchildren
95% of the people that have HIV live in the 95% of the people that have HIV live in the developing worlddeveloping world
CDC Division of HIV/AIDS Prevention
HIV/AIDS Statistics ContHIV/AIDS Statistics Cont
Half of the 5 million new infections in the past Half of the 5 million new infections in the past year occurred among individuals between 15 year occurred among individuals between 15 and 24 years of ageand 24 years of age
In the United States one quarter of new In the United States one quarter of new infections occur in youths age 13-21 at a rate infections occur in youths age 13-21 at a rate of one new infection every hourof one new infection every hour
Children’s Friends for Life
AIDS OrphansAIDS Orphans
Includes children who have lost either their Includes children who have lost either their father, mother, or both to AIDSfather, mother, or both to AIDS
By 2010 there will be 25 million living AIDS By 2010 there will be 25 million living AIDS orphans orphans
Earlier estimates put the number at 40 million, Earlier estimates put the number at 40 million, but it does not take into account the 15 million but it does not take into account the 15 million AIDS orphans that will die in the next 8 yearsAIDS orphans that will die in the next 8 years
UNICEF and UNAIDS
Mother to Infant TransmissionMother to Infant Transmission
Without interventions 35% of infants born to Without interventions 35% of infants born to HIV-positive mothers will contract HIVHIV-positive mothers will contract HIV
Of these:Of these: 15-20% occur during pregnancy15-20% occur during pregnancy 50% occur during labor and delivery50% occur during labor and delivery 33% occur during breastfeeding33% occur during breastfeeding
The Breastfeeding DilemmaThe Breastfeeding Dilemma
Infants can contract HIV through Infants can contract HIV through breastfeedingbreastfeeding
In developing countries formula is often not In developing countries formula is often not available or extremely expensiveavailable or extremely expensive
If formula is available, clean water often is notIf formula is available, clean water often is not
DiagnosisDiagnosis
An infant less than 18 months of age is An infant less than 18 months of age is considered HIV-infected if they are considered HIV-infected if they are seropositive, or were born to an HIV infected seropositive, or were born to an HIV infected mother and has positive results on two mother and has positive results on two separate HIV testsseparate HIV tests
An infant can be excluded by the An infant can be excluded by the disappearance of anti-HIV antibody by 18 disappearance of anti-HIV antibody by 18 months of age (seroreversion)months of age (seroreversion)
Major Problems Associated with Major Problems Associated with HIV/AIDSHIV/AIDS
MalnutritionMalnutrition Growth failureGrowth failure Developmental delaysDevelopmental delays Micronutrient deficienciesMicronutrient deficiencies Neurological problemsNeurological problems Opportunistic infectionsOpportunistic infections Normal childhood illnesses are potentially Normal childhood illnesses are potentially
fatalfatal
Problems ContinuedProblems Continued
If you have a child with AIDS you generally If you have a child with AIDS you generally have a family with AIDShave a family with AIDS
Socioeconomic statusSocioeconomic status Access to medicationAccess to medication
MalnutritionMalnutrition
Impaired nutritional absorptionImpaired nutritional absorption Increased nutritional requirementsIncreased nutritional requirements Reduced food intakeReduced food intake
Impaired Nutritional AbsorptionImpaired Nutritional Absorption
HIV-induced diarrheaHIV-induced diarrhea DehydrationDehydration Lactose intoleranceLactose intolerance Opportunistic infectionsOpportunistic infections
CryptosporidiosesCryptosporidioses TuberculosisTuberculosis
Gastric acid hypersecretion Gastric acid hypersecretion Drug interactionsDrug interactions
Increased Nutritional RequirementsIncreased Nutritional Requirements
Metabolic activity changesMetabolic activity changes Alterations in the function of the GI tractAlterations in the function of the GI tract Alteration in their ability to use food efficientlyAlteration in their ability to use food efficiently Increased use of body fat storesIncreased use of body fat stores Recurrent fevers and infectionsRecurrent fevers and infections Depletion of vitamin and mineral storesDepletion of vitamin and mineral stores
Increased calorie needsIncreased calorie needs
Reduced Food IntakeReduced Food Intake
Partially due to neurological involvementPartially due to neurological involvement Abnormal swallowing mechanismsAbnormal swallowing mechanisms Gastroesophageal reflux Gastroesophageal reflux AspirationAspiration Decrease in taste and appetiteDecrease in taste and appetite Regression of eating skillsRegression of eating skills
Oral lesions and HIV-specific gingivitis and gum Oral lesions and HIV-specific gingivitis and gum diseasedisease
Drug induced nausea, gastric irritation and drug Drug induced nausea, gastric irritation and drug volume and schedulesvolume and schedules
Psychological problems such as depressionPsychological problems such as depression
Neurological and Developmental Neurological and Developmental ProblemsProblems
Impaired brain growthImpaired brain growth Progressive motor dysfunctionProgressive motor dysfunction Loss or leveling out of developmental Loss or leveling out of developmental
milestonesmilestones SeizuresSeizures Strokes Strokes
Nutrient DeficienciesNutrient Deficiencies
Vitamin A (18-50%)Vitamin A (18-50%) Vitamin E (27%)Vitamin E (27%) Vitamin C (7%)Vitamin C (7%) Riboflavin (26%)Riboflavin (26%) Vitamin B6 (53%)Vitamin B6 (53%) Vitamin B12 (23%)Vitamin B12 (23%) Copper (74%)Copper (74%) Zinc (50%)Zinc (50%) Selenium (10%)Selenium (10%)
Nutritional AssessmentNutritional Assessment
Detailed diet historyDetailed diet history Medication historyMedication history Anthropometric dataAnthropometric data Evaluation of weight changesEvaluation of weight changes Laboratory dataLaboratory data
What can be done?What can be done?
Early culturally acceptable dietary intervention Early culturally acceptable dietary intervention may help avoid growth failuremay help avoid growth failure
Small frequent feedingsSmall frequent feedings Nutrient supplementationNutrient supplementation Soft-textured, moist foods, at room Soft-textured, moist foods, at room
temperature (casseroles, eggs, pasta, and gravy temperature (casseroles, eggs, pasta, and gravy on meats)on meats)
Fluids may be tolerated better through a strawFluids may be tolerated better through a straw
What can be done?What can be done?
A tolerable anti-HIV regimen including a combination A tolerable anti-HIV regimen including a combination of three different medications, two reverse transcriptase of three different medications, two reverse transcriptase inhibitors and a protease inhibitor can cause weight inhibitors and a protease inhibitor can cause weight gain, improved mental functioning and a longer lifegain, improved mental functioning and a longer life
Aggressive treatment of opportunistic infections can Aggressive treatment of opportunistic infections can prevent the deterioration of nutritional statusprevent the deterioration of nutritional status
Estimate energy needs using a Metabolic Cart, RDA Estimate energy needs using a Metabolic Cart, RDA tables or the tables or the Bentler and Stannish Bentler and Stannish formula for catchup formula for catchup growth growth May be up to 200 kcal/kg and 4g protein/kgMay be up to 200 kcal/kg and 4g protein/kg
What can be done?What can be done? Evaluate feeding skills to see if tube feeding is Evaluate feeding skills to see if tube feeding is
necessary or total parenteral nutrition is necessary or total parenteral nutrition is necessarynecessary
For diarrhea:For diarrhea: Lactaid milk and yogurt productsLactaid milk and yogurt products Soy milkSoy milk Soluble forms of fiber (oatmeal, rice, bananas, Soluble forms of fiber (oatmeal, rice, bananas,
applesauce)applesauce) Replace fluid loss with electrolyte solutions such Replace fluid loss with electrolyte solutions such
as Pedialyteas Pedialyte
Tips for CaregiversTips for Caregivers
Watch for any changes in your child’s Watch for any changes in your child’s behaviorbehavior
Talk to your doctor before you give your child Talk to your doctor before you give your child any immunizations or booster shotsany immunizations or booster shots
Plastic and washable toys are preferredPlastic and washable toys are preferred Food safely is vitalFood safely is vital These children need a lot of love, don’t be These children need a lot of love, don’t be
afraid to touch themafraid to touch them
ReferenceReference
Eley B, Hussey G. Nutrition and human Eley B, Hussey G. Nutrition and human immunodeficiency virus in children. immunodeficiency virus in children. SA J Clin SA J Clin Nutr. 1999;89:190-195.Nutr. 1999;89:190-195.
Any Questions?Any Questions?