care_hiv_child - 1 Care of HIV-Infected Infants and...

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Unformatted text preview: 1 Care of HIV-Infected Infants and Children International Center for AIDS Care and Treatment Programs Columbia University Mailman School of Public Health 2 Learning Objectives Understand the goals of care for HIV-infected infants and children Describe reasons for close follow-up Demonstrate appropriate use of the major components of routine care for HIV-infected infants & children Categorize disease stage Prescribe PCP prophylaxis Perform tuberculosis screening Evaluate ARV eligibility Schedule pediatric visits as per ICAP protocols Antiretroviral therapy is discussed in a different training module International Center for AIDS Care and Treatment Programs, Columbia University 3 Model of care Family-centered HIV primary care Multidisciplinary team Maximize health & prevent disease progression Prevent early death Prevent OI Maximize growth and development Reduce hospitalization rate Reduce frequency of intercurrent illnesses International Center for AIDS Care and Treatment Programs, Columbia University ICAP Goals for Care of HIV- Infected Infants & Children 4 Background: HIV Disease in Children Rapid disease course compared with adults Bimodal distribution of disease manifestations >30% with rapid disease progression Majority with symptoms by 12 months 50% mortality by 24 months <5% long term nonprogressors International Center for AIDS Care and Treatment Programs, Columbia University 5 Common Clinical Manifestations Infancy and early childhood - rapid progression poor growth/failure-to-thrive/weight loss pneumonia (PCP & TB) encephalopathy recurrent, severe infections diarrhea Older children poor growth recurrent infections lymphoid interstitial pneumonia (LIP) dermatitis Clinical manifestations vary considerably International Center for AIDS Care and Treatment Programs, Columbia University 6 HIV Causes Increased Mortality in Children International Center for AIDS Care and Treatment Programs, Columbia University Newell et al. Lancet 2004 7 3 year old with HIV encephalopathy, Failure-To-Thrive, Recurrent Infections International Center for AIDS Care and Treatment Programs, Columbia University 8 11 year old with Varicella Zoster International Center for AIDS Care and Treatment Programs, Columbia University 9 Background: HIV Disease in Children (cont) HIV during infancy = primary infection Acquisition of HIV can occur in utero Intrapartum postnatally through breast feeding Very high viral load; peak at 6-12 weeks of life Maturing/developing immune system of the newborn International Center for AIDS Care and Treatment Programs, Columbia University 10 Rouet F, et al. Pediatrics 2003;112e:289 Plasma HIV-1 RNA in 80 Children by Timing of Infection, Cote dIvoire International Center for AIDS Care and Treatment Programs, Columbia University 11 Background: HIV Disease in Children (cont)...
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care_hiv_child - 1 Care of HIV-Infected Infants and...

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