when to suspect hiv in children
DESCRIPTION
When to suspect HIV in children. A clinical perspective. 16 month old boy. Fever, increased work of breathing, poor feeding. Normal pregnancy – LSCS at term Breast fed 2/12: facial swelling 11/12: severe chicken pox No developmental progress after age 1 year. Family history. - PowerPoint PPT PresentationTRANSCRIPT
When to suspect HIV When to suspect HIV in childrenin children
A clinical perspectiveA clinical perspective
16 month old boy16 month old boy
Fever, increased work of Fever, increased work of breathing, poor feeding.breathing, poor feeding.
Normal pregnancy – LSCS at term Normal pregnancy – LSCS at term Breast fedBreast fed2/12: facial swelling2/12: facial swelling11/12: severe chicken pox11/12: severe chicken poxNo developmental progress after No developmental progress after age 1 year.age 1 year.
Family historyFamily history
Parents from ZimbabweParents from ZimbabweMum nurse – in UK for 8 yearsMum nurse – in UK for 8 yearsDad student – in UK for 3 yearsDad student – in UK for 3 yearsMum reported negative HIV test Mum reported negative HIV test 3 years ago3 years ago
HIV diseaseHIV disease
Pneumocystis pneumoniaPneumocystis pneumoniaCMV pneumonitisCMV pneumonitisCMV retinitisCMV retinitisCMV/HIV encephalopathyCMV/HIV encephalopathy
SequelaeSequelae
Marrow failureMarrow failure GanciclovirGanciclovir ZidovudineZidovudine CotrimoxazoleCotrimoxazole
Pseudomonas Pseudomonas sepsissepsis
Renal failureRenal failure GanciclovirGanciclovir FoscarnetFoscarnet AminoglycosidesAminoglycosides
Where are we now?Where are we now?
HIV undetectable HIV undetectable Immune reconstitution Immune reconstitution Normal respiratory functionNormal respiratory function Marrow recovered Marrow recovered Neurodevelopmental progress but Neurodevelopmental progress but delayeddelayedBUTBUT
Chronic renal failureChronic renal failure on dialysison dialysis
Girl aged 4 months, 29 Girl aged 4 months, 29 daysdays
Persistent cough, 2-3 monthsPersistent cough, 2-3 months3 courses antibiotics3 courses antibiotics
Pale, lethargicPale, lethargicFeeding normallyFeeding normallyNormal pregnancy, deliveryNormal pregnancy, deliveryCaucasian mother, no relevant Caucasian mother, no relevant PMH PMH
Initial investigationsInitial investigations
Hb 10.6Hb 10.6 WBC 8.0WBC 8.0 Pl 316Pl 316 Bili 6Bili 6 AST 384AST 384 ALT 283ALT 283 ALP 362ALP 362 CRP <7CRP <7
No organisms No organisms identifiedidentified
CXR:CXR: hyperinflation hyperinflationdiffuse diffuse interstitial interstitial changes ? Viralchanges ? Viral
Abd US:Abd US:liver and spleen liver and spleen enlarged, normal enlarged, normal texturetexture
ProgressProgress
Increasing oxygen requirementIncreasing oxygen requirementMax 3 litresMax 3 litres
Improved with antibioticsImproved with antibioticsHome after 4 daysHome after 4 daysReadmitted 8 days laterReadmitted 8 days laterPale, lethargic, breathlessPale, lethargic, breathlessVentilatedVentilated
Further investigationsFurther investigations
WBC 5.5WBC 5.5 IgG 8.89IgG 8.89 Lymph 2.11Lymph 2.11 IgA 2.03IgA 2.03 CD3 1.22CD3 1.22 IgM 2.45IgM 2.45 CD4 0.80CD4 0.80 CD8 0.40CD8 0.40 CD19 0.38CD19 0.38 CD56 0.21CD56 0.21 Poor lymphocyte Poor lymphocyte proliferationproliferation
Normal:Normal: Sweat test Sweat test Urine and Urine and plasma amino plasma amino acids acids
Organic Organic acidsacids
Pneumocystis from BALHIV antibody and RNA positive
AIDS defining conditionsAIDS defining conditions
PneumocystisPneumocystis CMV pneumonitisCMV pneumonitis TBTB
HIV HIV encephalopathy/encephalopathy/
Meningitis/Meningitis/encephalitisencephalitis
Kaposi sarcomaKaposi sarcoma LymphomaLymphoma
Wasting syndromeWasting syndrome Persistent Persistent cryptosporidiosicryptosporidiosiss
CMV retinitisCMV retinitis Recurrent Recurrent bacterial bacterial infectioninfection
PUOPUO
Barriers to diagnosisBarriers to diagnosis
UncommonUncommonMay not present with May not present with opportunistic infectionopportunistic infection
CD4 count often in “adult” CD4 count often in “adult” normal rangenormal range
CD4:CD8 ratio can be normalCD4:CD8 ratio can be normalIssues around testingIssues around testing
Who needs to think Who needs to think about HIV?about HIV?
ENT surgeonENT surgeon
Chronic Chronic parotitisparotitis
Severe Severe chronic/recurrent chronic/recurrent otitis mediaotitis media
DentistDentist
Oral candidiasisOral candidiasis Poor dental Poor dental hygienehygiene
RespiratoryRespiratory
Lymphocytic interstitial Lymphocytic interstitial pneumonitispneumonitis
Recurrent pneumoniaRecurrent pneumoniaBronchiectasisBronchiectasis
NeurologistNeurologist
Unexplained Unexplained encephalopathy/encephalitisencephalopathy/encephalitis
Developmental delayDevelopmental delayChildhood strokeChildhood stroke
DermatologistDermatologist
Severe Severe dermatitisdermatitis
Fungal infectionFungal infection
Extensive Extensive molluscummolluscum
Extensive wartsExtensive warts
GastroenterologistGastroenterologist
Chronic Chronic diarrhoea and diarrhoea and wastingwasting
Unexplained Unexplained hepatosplenomegahepatosplenomegalyly
Haemato-oncologistHaemato-oncologist
LymphomaLymphoma ThrombocytopoeniThrombocytopoenia/a/neutropoenia/neutropoenia/lymphopoenialymphopoenia
OphthalmologistOphthalmologist
Unexplained retinopathyUnexplained retinopathy
General paediatricianGeneral paediatrician
Developmental delayDevelopmental delayFailure to thriveFailure to thrivePersistent generalised Persistent generalised lymphadenopathylymphadenopathy
Recurrent respiratory infectionRecurrent respiratory infectionRecurrent bacterial infectionRecurrent bacterial infectionMuco-cutaneous candidiasisMuco-cutaneous candidiasisRecurrent herpes zosterRecurrent herpes zosterSevere varicellaSevere varicella
GPGP
Developmental delayDevelopmental delay Failure to thriveFailure to thrive Persistent generalised Persistent generalised lymphadenopathylymphadenopathy
Recurrent respiratory infectionRecurrent respiratory infection Recurrent bacterial infectionRecurrent bacterial infection Muco-cutaneous candidiasisMuco-cutaneous candidiasis Recurrent herpes zosterRecurrent herpes zoster
The child may be completely The child may be completely well!well!
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child parent
Shared
Glasgow
Who should be Who should be thinking about HIV thinking about HIV
testing?testing?
Everybody!Everybody!