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Exam 4-DWB > HIV in children > Flashcards

HIV in children Flashcards

1
Q

Standard of care for perinatal HIV infection

A
  1. all pregnant women receive counseling and testing for HIV early in pregnancy
  2. repeat testing for all high-risk HIV-negative women
  3. rapid HIV test intrapartum for HIV-unknown so intrapartum antiretrovirals can be given
  4. consider C-section to prevent transmission to baby
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2
Q

what is the most common test for HIV

A

antibody test ELISA and confirmed by Western blot

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3
Q

Best test for HIV

A

HIV DNA PCR

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4
Q

Confirmation or alternative testing for HIV

A

HIV RNA assay for viral load

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5
Q

In a baby when should antibody retesting be done

A

after 18 months of age

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6
Q

HIV medication for exposed infants

A

Zidovudine 2mg/kg/dose 4 x day within 8-12 hours after birth and continue for 6 weeks

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7
Q

HIV medication for exposed infants whose mothers were not on therapy

A

Zidovudine and Nevirapine

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8
Q

What is the landmark study on HIV and what did it show

A

ACTG 076 study on HIV-positive mothers and their infants.
Shows untreated mothers had 25.5% chance of vertical transmission, and mother/baby treatments had 8.3% rate of transmission.
multiple med regiments has reduced rate to <2%

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9
Q

What condition has high mortality rate in HIV-positive infants

A

pneumocystic pneumonia (PCP)

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10
Q

What prophylaxis should be started on all infants born to HIV-positive mothers

A

Pneumocystic pneumonia at 6 weeks and take until HIV is ruled out completely

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11
Q

Important points to remember about HIV in infants

A
  1. mom can test negative

2. mom may have had “bad flu” that was actually HIV Infection

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12
Q

Risk factors for HIV in infants

A
  1. Chlamydia
  2. hepatitis C positive
  3. clinic hoping
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13
Q

What symptoms are common in HIV-positive children

A
  1. FTT

2. irritability

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14
Q

Symptoms of HIV during first 6 weeks of life

A

usually asymptomatic

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15
Q

first symptoms in pediatric patients with HIV

A 
first - lymphadenopath
2. enlarged liver and spleen
3. FTT
4. encephalopathy
5 low birth weight
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16
Q

What symptoms of HIV in pediatric patients develop over time

A
  1. diarrhea
  2. pneumonia
  3. thrush
  4. opportunistic infections
17
Q

complications that can develop in pediatric patients with HIV

A
  1. cardiac hypertrophy/CHF
  2. anemia
  3. malignancies
18
Q

what percent of untreated HIV-positive infants will die by age 4

A

15-20%

19
Q

80% of HIV-positive infants will have symptoms by what age

A

12 months

20
Q

Management of HIV-positive child

A
  1. comanage with HIV specialist
  2. antiretroviral meds based on CD4 count and clinical manifestation
  3. monitor for opportunistic/bacterial infection/malignancies
  4. vaccinate for flu/ live viruses risky
21
Q

Lab monitoring for pediatric patient with HIV

A
  1. use CD4 % test for child under 5 years
  2. check CD4 % every 3-4 months
  3. check HIV RNA {viral load} every 3-4 months
22
Q

What children have highest risk of HIV progression

A

children under 1 year;

children > 5 years are comparable to adults

23
Q

What are the goals to antiretroviral therapy

A
  1. reduce plasma HIV RNA to below detectable level
  2. normalize immune status
  3. reduce HIV-related mortality and morbidity
  4. restore/preserve immune function
  5. suppress viral replication
  6. maintain normal growth and cognitive development
  7. minimize drug-related toxicity
  8. optimize QOL
24
Q

strategies for HIV treatment in peds

A
  1. use combo agents {3 drugs from at least 2 categories}

2. maximize adherence

25
Q

choice of HIV medications are based on

A
  1. HIV type
  2. future treatment options
  3. drug resistance and cross-resistance
26
Q

side effects of HIV meds should prompt what

A

reevaluation of antiretroviral regimen

27
Q

Common side effects of antiretroviral medications: hematologic

A

drug-induced bone marrow suppression

28
Q

Common side effects of antiretroviral medications: mitochondrial dysfunction

A
  1. lactic acidosis
  2. hepatic toxicity
  3. pancreatitis
29
Q

Other common side effects of antiretroviral meds

A
  1. lipodystrophy

2. metabolic abnormalities

30
Q

Why should a care provider not reduce drug doses of HIV meds

A

risk of drug resistance

31
Q

Two cohorts of adolescents with HIV

A
  1. those with perinatal exposure

2. those newly infected

32
Q

Important points about antiretrovirals and contraception

A

always use but know that they may interact with antiretrovirals

Exam 4-DWB (20 decks)

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