Paediatric HIV

Question 1

 20 years ago, there was no way to prevent or treat child ___ infection

Answer 1

HIV

Question 2

 ____ OF HIV+ are on ARVs (2019)

Answer 2

47%

Question 3

 New infections ______ since 2010 (10k new infections in 2019)

Answer 3

halved

Question 4

______ children living with HIV (2019)

Answer 4

340k

Question 5

_______________________________ is a fast-track framework created by global organisations

Answer 5

Start Free, Stay Free, AIDS Free

Question 6

Start free - Prevent Mother to Child Transmission (PMTC)

High viral load is =

Answer 6

High viral load is = increased risk of transmission

Question 7

Start free - Prevent Mother to Child Transmission (PMTC)

Strategy 1 (most important goal of PMTC):

Answer 7

Strategy 1 (most important goal of PMTC): early, rapid and sustained maternal viral load suppression

Question 8

Start free - Prevent Mother to Child Transmission (PMTC)

Strategy 2:

Answer 8

Infant PEP (NVP/AZT)

Question 9

What is the goal regarding pregnant women living with HIV according to the provided information?

Answer 9

The goal is to reach 95% of pregnant women living with HIV and sustain them on lifelong antiretroviral therapy.

Question 10

What is one of the objectives related to preventing HIV transmission in women of childbearing potential?

Answer 10

One objective is to prevent primary HIV infection among women of childbearing potential.

Question 11

How is preventing unwanted pregnancies among HIV-positive women addressed?

Answer 11

Preventing unwanted pregnancies among HIV-positive women is addressed as one of the objectives.

Question 12

What is the importance of prevention of mother-to-child transmission (PMTCT) programs?

Answer 12

Without PMTCT programs, 1 in 3 babies born to HIV-positive mothers will become HIV-positive. With single-dose Nevirapine during delivery, this risk decreases to 1 in 10. With antiretroviral therapy (ART) for mothers and post-exposure prophylaxis (PEP) for babies, the risk further decreases to 1 in 100.

Question 13

How should HIV-positive mothers be supported according to the provided information?

Answer 13

HIV-positive mothers should be provided with appropriate treatment, care, and support, and efforts should be made to engage fathers in this process.

Question 14

Antenatal:

Postpartum:

Answer 14

Question 15

 Mothers should adhere to _____ and have their viral loads monitored throughout pregnancy and breastfeeding

 Breastfeeding is encouraged in HIV+ mothers because benefits outweigh the _______

 BF+ aims to prevent ____ in breastfeeding HIV- and HIV+ women

Answer 15

ART
harms
MTC

Question 16

Infant Prophylaxis at Birth:

Principle 1 -

Answer 16

Question 17

Infant Prophylaxis at Birth:

Principle 2 -

Answer 17

Question 18

Infant Prophylaxis at Birth:

Principle 3 -

Answer 18

Question 19

Definition 1

Low Risk =

Answer 19

Question 20

Definition 2

High Risk =

Answer 20

Question 21

For breastfeeding infants on high-risk prophylaxis: If maternal viral load is not suppressed by 12 weeks, continue NVP prophylaxis until maternal VL is ________, or until 1 week after breastfeeding stops

Answer 21

<1000c/ml

Question 22

What age group of adolescents needs urgent intervention for the prevention of new HIV infections, particularly among girls?

Answer 22

Adolescents aged 15-19 years old, especially girls, require urgent intervention due to high transmission rates and disempowerment in negotiating condom use.

Question 23

What are some recommended interventions for preventing new HIV infections in adolescents?

Answer 23

Recommended interventions include talking to children about sex and consent, voluntary male circumcision, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), access to secondary and higher education, and integration of sexual and reproductive services with HIV services for young people.

Question 24

Why are 15-19-year-old girls particularly vulnerable to HIV infection?

Answer 24

15-19-year-old girls are particularly vulnerable due to high transmission rates and challenges in negotiating condom use, often stemming from social and gender-related factors that disempower them.

Question 25

What is PrEP and how does it help in preventing HIV infections?

Answer 25

PrEP stands for pre-exposure prophylaxis, which involves taking antiretroviral medication regularly to prevent HIV infection in individuals who are at high risk. It provides an additional layer of protection against HIV transmission.

Question 26

How can the integration of sexual and reproductive health services with HIV services benefit young people?

Answer 26

Integrating sexual and reproductive health services with HIV services ensures that young people have comprehensive access to prevention, testing, and treatment services in one location, which can improve uptake and effectiveness of interventions.

Question 27

Define AIDs free:

Answer 27

Ensure ART access to 95% of HIV infected children

Question 28

Why do foetuses and newborns typically experience more rapid and extensive HIV replication compared to older hosts?

Answer 28

Foetuses and newborns have immature immune systems, leading to more rapid and extensive HIV replication. Consequently, there is a more rapid disease progression in children, with approximately 50% of HIV-positive children expected to die within two years without antiretroviral therapy (ART).

Question 29

How do viral loads in HIV-positive children change as they age?

Answer 29

Viral loads are higher in the first year of life and then decline to adult values by 5-6 years of age.

Question 30

What is the significance of CD4 counts in infants compared to older children and adults?

Answer 30

Absolute CD4 counts are much higher in infancy, with counts exceeding 3000 cells/mm³.

Question 31

How does the CD4 percentage change in children with HIV, and what does it correlate with?

Answer 31

The CD4 percentage remains constant in children and correlates with disease progression, serving as an important marker for monitoring HIV progression and treatment response.

Question 32

What are some strategies used to ensure access to ARTs?

Answer 32

 Diagnose ASAP (highest mortality between 6 weeks and 4 months)  Early diagnosis and treatment decreases risk of HIV encephalopathy and opportunistic infections  Treatment must be effective, well tolerated, simple and universal  Adults have 1 big tablet to take once a day but children have multiple syrups (some are bad tasting) and vitamins that need to take bidaily – this is unfair. Additional TB medication is even worse

Question 33

Cher study – when to start ART?

Answer 33

* Diagnosis and tx before 3 months of age showed much better outcomes (decreases mortality and developmental delay)

Question 34

Non-progressors: (3)

Answer 34

Question 35

Slow progressors: (3)

Answer 35

Question 36

Rapid progressors: (3)

Answer 36

Question 37

National ART regimens: < 20kg

Answer 37

Abacavir (ABC) + Lamivudine (3TC) + Lopinavir (LPV/r) ifn<20kg

Question 38

National ART regimens: > 20kg

Answer 38

Dolutegravir (DTG) if > 20kg

Question 39

Psychosocial criteria to start child on ART: Mandatory:

Answer 39

At least one identifiable caregiver who is able to supervise child or administer medication

Question 40

Psychosocial criteria to start child on ART: Recommended:

Answer 40

Disclosure to another adult living in the same house is encouraged so that there is someone else who can assist with the child’s ART

Question 41

Criteria for fast-tracking for ART:

Answer 41

Question 42

Is disclosure of HIV status a one-time event?

Answer 42

No, disclosure of HIV status is an ongoing process, not a one-time event.

Question 43

At what age should HIV status be properly explained to children?

Answer 43

HIV status should be properly explained to children at 8-9 years old, and the topic should be revisited at every visit thereafter.

Question 44

At what age do individuals have a legal right to know their HIV status?

Answer 44

Individuals have a legal right to know their HIV status at 12 years of age.

Question 45

Who ideally should disclose HIV status to children?

Answer 45

Ideally, HIV status should be disclosed by caregivers, such as parents or guardians.

Question 46

How does disclosure of HIV status contribute to improved health outcomes?

Answer 46

Disclosure of HIV status improves adherence to treatment and mental health, as it is the number one predictor of poor adherence.

Question 47

What are the pharmaceutical Challenges for Paediatric ART? (5)

Answer 47

Question 48

How many children globally are in need of antiretroviral treatment (ART), and what percentage are on a suboptimal regimen?

Answer 48

Globally, 2.1 million children are in need of ART, with 40% of them on a suboptimal regimen.

Question 49

What is a common concern regarding the available formulations for paediatric ART?

Answer 49

A common concern is that there is "too much of what we don’t need," indicating that the current formulations may not adequately meet the needs of children living with HIV.

Question 50

Care of the HIV-exposed but Uninfected (HEU) infant 3.8 million HEUs – higher risk for growth deficits, neurodevelopmental delays, infections and death Identify high-risk HEU infants and ensure more regular monitoring for: (5)

Answer 50