Microbiology 7 - HIV in African children

Question 1

What is the most important risk factor for mother to child HIV transmission?

Answer 1

Maternal plasma viral load

Question 2

Recall some clinical features of HIV in children, as well as some of the tell-tale infections they can get

Answer 2

Molluscum on face
Swelling of parotids
Lymphadenopathy
Oral candidiasis (which can extend to oesophagus) 
Sinusitis
Lymphoid interstitial pneumonitis 
Shingles >1 dermatome
PML / Progressive Multifocal Leukoencephalopathy

Question 3

What structural brain changes may be present in HIV encephalopathy?

Answer 3

Basal ganglia calcification
Atrophy
White matter changes
Vasculopathy, stroke

Question 4

What is lymphoid interstitial pneumonitis

Answer 4

• lymphoproliferation due to immune activation – if lymphoid tissue contracts → bronchiectasis and chronic suppurative lung pathology + clubbing
• impossible to distinguish from TB on CXR

Question 5

What is PML / Progressive Multifocal Leukoencephalopathy

Answer 5

HIV infecting oligodendrocytes → ↓ neuronal nutrition → progressive neuronal cell death

Question 6

Which malignancy is associated with HIV?

Answer 6

Kaposi sarcoma (HHV8)

Question 7

How can HIV be transmitted perinatally?

Answer 7

• Breast feeding
• In utero
• Intra-partum (i.e. when giving birth)

Question 8

How should ARVs used in pregnancy/breastfeeding women?

Answer 8

initiate triple ARVs

• Fixed dose combination Tenofovir+3TC+efavirenz
• BF infants should receive daily NVP for 6 weeks

Question 9

What is the ARROW trial?

Answer 9

no difference in outcome when clinical monitoring is compared to laboratory monitoring

Question 10

Indications for initiation of ART in children <5yo

Answer 10

regardless of anything, just TREAT them