HIV Infection in Children and Adolescents 3030354326, 9783030354329

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Table of contents :
Foreword
Contents
1: Introduction and Epidemiology
1.1 History
1.2 Epidemiology and Burden of Disease
1.3 Funding
1.4 Molecular Epidemiology
1.5 Continuum of Care
1.6 Conclusion
References
2: Transmission and Immunopathogenesis
2.1 Transmission
2.2 The Virus
2.3 Life Cycle of the Human Immunodeficiency Virus
2.4 Immunopathogenesis
2.5 Eradication of the Virus
References
3: Diagnosis of HIV Infection in Children and Adolescents
3.1 Introduction
3.2 HIV Tests
3.3 Diagnostic Complexities
3.4 Diagnostic Guidelines
References
4: Clinical Manifestations
4.1 Introduction
4.2 The Natural History of Paediatric HIV Infection
4.3 Classification of HIV Infection
4.4 Signs and Symptoms of HIV Infection
4.4.1 Malnutrition and Growth Failure
4.4.2 Recurrent Infections
4.4.3 Respiratory Disease
4.4.4 Tuberculosis
4.4.5 Gastrointestinal Tract Disease
4.4.6 Neurological Disorders
4.4.7 Haematological Abnormalities and Malignancies
4.4.8 Cardiovascular Manifestations
4.4.8.1 Renal Disease
4.4.8.2 Opportunistic Infections
References
5: Cutaneous Manifestations of HIV in Children
5.1 Introduction
5.2 Infections
5.2.1 Viral Infections
5.2.1.1 Herpes Simplex Virus
Clinical Presentation
Complications
Management
5.2.1.2 Varicella Zoster
Complications
Management
5.2.1.3 Herpes Zoster
Clinical Presentation
Management
5.2.1.4 Molluscum Contagiosum
Clinical Presentation
Complications
Management
5.2.1.5 Verrucae
Plane Warts (Verruca Plana)
Verruca Vulgaris
Condyloma Accuminata (Anogenital Warts)
Management
5.2.2 Bacterial Infections
5.2.3 Fungal Infections
5.2.3.1 Superficial Fungal Infection
Tinea Infection
Tinea Capitis
Clinical Presentation
Management
Non-Drug Therapy
Drug Therapy
Tinea Corporis, Cruris and Faciei
Clinical Presentation
Management
Tinea pedis
Clinical Presentation
Management
Onychomycosis
Clinical Presentation
Diagnosis
Differential Diagnosis
Management
Oral Candidiasis
Management
5.3 Inflammatory Conditions
5.3.1 Seborrhoeic Dermatitis
5.3.2 Papular Pruritic Eruption of HIV (PPE)
5.4 Infestation
5.4.1 Scabies
5.5 Drug Reaction
5.5.1 Steven Johnson Syndrome
5.6 Immune Reconstitution Inflammatory Syndrome (IRIS)
5.7 Conclusion
References
6: Respiratory Diseases Amongst HIV Infected Children
6.1 Epidemiology
6.2 Classification of HIV Related Respiratory Infections and Disease
6.3 Clinical Presentation
6.4 Upper Airway Diseases
6.5 Lower Airways Diseases
6.5.1 Etiology of Acute Opportunistic Infections Related to Pneumonia
6.5.1.1 Bacterial Infections
6.5.1.2 Viral Infections
6.5.1.3 Fungal Pneumonia
6.5.1.4 Polymicrobial Infection
6.6 Aetiology of Chronic Lung Disease
6.6.1 Lymphoid Interstitial Pneumonitis (LIP)
6.6.2 Kaposi Sarcoma
6.6.3 Lymphoma
6.7 Risk Factors for Acquiring Respiratory Diseases
6.8 Sampling and Laboratory Testing
6.9 Treatment of HIV Infected Children with Pneumonia
6.9.1 Supportive Care
6.9.2 Antimicrobial Therapy
6.9.3 Corticosteroids
6.9.4 Advance Supportive Management
6.10 Complications of HIV Related Lung Disease
6.10.1 Chronic Obstructive Airway Disease: Bronchiectasis and Constrictive Bronchiolitis Obliterans
6.10.2 Immune Reconstitution Inflammatory Syndrome (IRIS)
6.10.3 Malignant Transformation of Lymphoid Interstitial Pneumonitis
6.11 Preventative Measures
6.11.1 Effective ART
6.11.2 Vaccination
6.11.3 TB Prophylaxis (TPT)
6.11.4 Co-trimoxazole Prophylaxis (CPT)
6.12 Prognosis
6.13 Follow Up
References
7: Gastrointestinal Tract
7.1 Introduction
7.2 Oral Pathology: Periodontal Disease, Ulcers, Pain and Xerostomia
7.3 Dysphagia (Difficult Swallowing) and Odynophagia (Painful Swallowing)
7.4 Vomiting
7.5 Abdominal Pain
7.6 Acute Diarrhoea
7.7 Persistent or Chronic Diarrhoea
7.8 Liver Disease
7.9 Malnutrition
References
8: HIV Related CNS Disorders in Children
8.1 Introduction
8.2 Epidemiology
8.3 Neuropathology of CNS HIV Infection
8.4 Neuropsychological Profile of HIV Infected Children
8.5 HIV Encephalopathy
8.5.1 HIV Encephalopathy Presents with Three Recognized Clinical Developmental Stages
8.6 Motor Impairment
8.7 Cognitive Impairment
8.8 Behaviour and Attention Dysfunction
8.9 Language and Communication Disorders
8.10 Language Processing Disorders
8.11 Articulation Disorders
8.12 Symptomatic Epilepsy
8.13 CNS Infections
8.14 Neuroimaging in HIV CNS Disease
8.15 Assessment and Intervention Strategies
8.15.1 Medical Management
References
9: Cardiovascular Manifestation of Paediatric HIV Infection
9.1 Paediatric HIV Infection and Myocardial Function
9.2 Cardiac Failure in Children with HIV
9.2.1 Causes of Cardiomyopathy
9.2.2 Clinical Findings
9.2.3 Management of Cardiac Failure and Cardiomyopathy
9.3 Pericarditis and Pericardial Effusions
9.4 Cor Pulmonale and Pulmonary Hypertension
9.5 Coronary Artery Disease in HIV Infected Children
9.6 HIV Infection and Prolonged Corrected QT Interval
References
10: Haematological Manifestations of HIV Infection
10.1 Introduction
10.2 Pathophysiology
10.2.1 Effect of Medication on Haemopoiesis
10.3 Haematological Changes in Different Phases of Infection
10.3.1 In Primary Infection
10.3.2 Established Infection
10.3.3 Features in AIDS
10.4 Anaemia
10.5 Abnormalities of Myelopoeisis
10.6 Thrombocytopenia
10.7 Abnormalities of Coagulation
10.8 Effects of Tumours on Haemopoeisis
10.9 Peripheral Blood and Bone Marrow Abnormalities
10.10 Transfusions in HIV Positive Patients
10.11 Conclusion
References
11: Malignancies
11.1 Background
11.1.1 AIDS Defining (ADC) and Non-AIDS Defining Cancers (NADC)
11.2 Pathogenesis
11.2.1 Background Lymphoproliferation
11.2.2 Role of Co-infection
11.2.3 The Cytokine Syndrome Associated with HHV8/KSHV Inflammatory Cytokine Syndrome (KICS)
11.3 Cancers
11.3.1 AIDS Defining Cancers (ADC)
11.3.1.1 Kaposi Sarcoma (KS)
11.3.1.2 Non-Hodgkin Lymphoma (NHL)
Burkitt’s Lymphoma (BL), Burkitt-Like Lymphoma and High Grade B Cell Lymphomas
Plasmablastic Lymphoma
Primary CNS Lymphoma (PCNSL)
11.3.1.3 Other B Cell Lymphomas: Primary Effusion lymphoma (PEL)
11.3.1.4 Other ADC
11.3.2 Non-AIDS Defining Cancers (ADC)
11.3.2.1 Hodgkin Disease (HD)
11.3.2.2 Leiomyosarcoma
11.3.2.3 Intracranial Myopericytoma
11.3.3 Incident Cancers (Paediatric Malignancies: Non-AIDS Defining Cancers (NADC))
11.3.4 Dual Cancers
11.4 Emerging Patterns and Impact of ART
11.4.1 Trends Worldwide
11.4.2 Local Trends: Late Presenters and Missed Early Diagnosis
11.4.3 Cancer in Patients with Restored and or Preserved Immunity
11.5 The Future
References
12: HIV-Related Kidney Diseases
12.1 Introduction
12.2 Pathogenesis of HIV-Associated Nephropathy
12.3 Pathogenesis of HIV Immune Complex Kidney Disease (HIVICK)
12.4 Clinical Presentation
12.5 Diagnosis of HIV-Associated Nephropathy
12.6 Clinical Presentation of Other HIV-Related Kidney Diseases in Children with HIV-Infection
12.6.1 Urinary Tract Infection
12.6.2 Acute Interstitial Nephritis
12.6.3 Vasculitides
12.6.4 Thrombotic Microangiopathy (TMA)
12.6.5 Electrolyte and Acid-Base Disorders
12.7 Treatment of HIV-Associated Nephropathy (HIVAN)
12.8 Dialysis in Children with End Stage Kidney Disease Secondary to HIV-Related Kidney Disease
12.9 Transplantation in HIV-Infected Children
References
13: Rheumatological Manifestations of HIV Infection
13.1 Introduction
13.2 Spectrum of Rheumatological Manifestations
13.2.1 Arthralgia
13.2.2 Arthritis
13.2.2.1 Pathogenesis
13.2.2.2 Clinical Presentation
13.2.2.3 Management
13.2.3 HIV Associated Muscle Disease
13.2.3.1 Pathogenesis
13.2.3.2 Clinical Presentation
13.2.3.3 Treatment
13.2.4 HIV Associated Vasculitis
13.2.4.1 Pathogenesis
13.2.4.2 Clinical Presentation
13.2.4.3 Investigations
13.2.4.4 Treatment
13.2.5 Systemic Lupus Erythematosus
13.2.6 Rheumatological Manifestations Associated with Antiretroviral Therapy
13.2.7 Serological Abnormalities
13.3 Summary
References
14: Opportunistic Infections
14.1 Introduction
14.2 Bacterial Infections
14.2.1 Pneumonia
14.3 Fungal Infections
14.3.1 Pneumocystis jirovecii Pneumonia
14.3.2 Candida
14.3.3 Cryptococcosis
14.3.3.1 Clinical Characteristics
14.3.3.2 Diagnostic Tests
14.3.3.3 Treatment
14.3.3.4 Secondary Prophylaxis (Maintenance)
14.3.3.5 Screening for at-Risk HIV Positive Patients
14.4 Viruses
14.4.1 Herpes Simplex Virus (HSV)
14.4.2 Cytomegalovirus (CMV)
14.4.2.1 Seroepidemiology
14.4.2.2 Pathophysiology
14.4.2.3 Impact of HIV on Congenital CMV
14.4.2.4 The Impact of CMV on HIV Progression
14.4.2.5 Clinical Disease in Children with HIV Infection
14.4.2.6 Diagnostic Tests
14.4.2.7 Treatment
14.4.3 Varicella Zoster Virus (VZV)
14.4.3.1 Diagnosis and Treatment
14.4.4 Hepatitis B
14.4.4.1 Epidemiology
14.4.4.2 Aetiology and Pathogenesis
14.4.4.3 Clinical Characteristics
14.4.4.4 Diagnosis
Serological Diagnosis
Molecular Methods
14.4.4.5 Screening
14.4.4.6 Treatment
Treatment Options for Children [27]
14.4.4.7 Prophylaxis
14.4.4.8 Prophylaxis in Infants Born to HBsAg Positive Mothers
14.4.5 HPV
14.4.5.1 Clinical Manifestations
14.4.5.2 Main Types Associated with Significant Disease
14.4.5.3 Epidemiology
14.4.5.4 Risk Factors for Developing Cervical Cancer
14.4.5.5 Screening Recommendations
14.4.5.6 Diagnosis
14.4.5.7 Prophylaxis
14.4.6 Rotavirus
14.5 Parasitic Infections
14.5.1 Giardiasis
14.5.2 Syphilis
14.5.2.1 Diagnosis, Screening and Treatment
14.5.3 Malaria
14.5.3.1 The Effect of HIV on Malaria
14.5.3.2 Diagnosis
14.5.3.3 Treatment
References
15: Tuberculosis and HIV in Children
15.1 Introduction
15.2 TB Disease and HIV
15.3 The Impact of Improved Vertical HIV Transmission Prevention
15.4 The HIV-Exposed Uninfected Child
15.5 Impact of ART on TB Disease
15.5.1 BCG
15.5.2 TB Infection in the HIV+ or HIV Exposed Uninfected Child
15.5.3 TB Diagnosis
15.5.4 Levels of Certainty for Pulmonary TB Diagnosis
15.5.5 Childhood Anti-TB Therapy and ART
15.5.6 Drug Resistant TB and HIV
15.5.7 The Immune Reconstitution Inflammatory Syndrome
15.5.8 TB Meningitis
15.6 Conclusion
References
16: Care and Management of a Neonate Born to an HIV Positive Mother
16.1 Introduction
16.2 Routes of Transmission and Prevention
16.3 Steps to Be Taken When a Baby Is Born to an HIV Positive Mother
16.3.1 Examination of the Newborn Baby
16.3.1.1 Effects on Growth
16.3.1.2 Assess for Hematologic and Metabolic Complications
16.3.1.3 Assess for Birth Defects
16.3.2 Evaluate for Infections
16.3.2.1 Sexually Transmitted Infections (STI)
16.3.2.2 Tuberculosis
16.3.2.3 Mastitis
16.3.2.4 Group B Streptococcal Sepsis
16.3.2.5 Hepatitis B
16.3.3 PCR Testing
16.4 Monitoring of a Neonate Who Is HIV Exposed but Uninfected (HEU)
16.5 Feeding Choices
16.6 Management of a Neonate Born to an HIV Positive Mother Includes (National South African Consolidated PMTCT Guidelines. Adapted from the WHO Recommendations)
16.7 Management of a Neonate Who Is HIV Infected
16.8 Additional Care (South African Guidelines)
16.9 Conclusion
References
17: Adolescents with HIV Infection
17.1 Definitions
17.2 Development
17.3 Adolescents and HIV
17.4 Adolescent Friendly Services
17.5 HIV Testing and Prevention
17.5.1 Condoms
17.5.2 VMMC
17.5.3 Viral Load Suppression
17.5.4 Diagnosing and Treating STIs
17.5.5 Post Exposure Prophylaxis (PEP)
17.5.6 Pre-Exposure Prophylaxis (PrEP)
17.6 HIV-Infected Adolescents and ART
17.7 Psychosocial Support
17.7.1 Adherence
17.7.2 Disclosure
17.7.3 Mental Health
17.8 Sexual and Reproductive Health
17.8.1 Pregnancy and Adolescents
17.9 Differentiated Care for HIV-Positive Adolescents
17.10 Transition
References
18: General Management
18.1 Management of an HIV-Exposed Child
18.1.1 Infant Prophylaxis
18.1.2 Diagnosis
18.1.3 Nutrition
18.1.3.1 Breastfeeding
18.1.3.2 Milk Formula Feeds
18.1.3.3 Opportunistic Infection Prophylaxis
18.1.4 Immunization
18.2 Management of an HIV-Infected Child/Adolescent
18.2.1 Nutrition
18.2.2 Opportunistic Infection Prophylaxis
18.2.2.1 Co-Trimoxazole Prophylaxis (CTX)
18.2.2.2 INH Prophylaxis
18.2.2.3 Fluconazole Prophylaxis
18.2.3 Immunization
18.2.4 Routine/General Care
References
19: Antiretroviral Treatment
19.1 Introduction
19.2 Mechanism of Action
19.3 Antiretroviral Drugs
19.4 Principles of ART Combination
19.5 Public Health Vs Individual Patient Management
19.6 Dosing
19.7 Monitoring
19.8 Management of Treatment Failure
19.9 HIV Drug Resistance
References
20: Prevention of Mother to Child Transmission of HIV
20.1 Introduction
20.2 Pathophysiology
20.2.1 Mechanisms of Transmission
20.2.2 Timing of Transmission
20.2.3 Risk Factors Affecting MTCT Transmission
20.2.3.1 Host Factors
20.2.3.2 Genetic
20.2.3.3 Tissue and Mucosal Integrity
20.2.3.4 Obstetric Factors
20.3 Epidemiology
20.3.1 International Perspective
20.3.2 The South African Perspective
20.4 Maternal HIV Testing and Identification of Perinatal HIV Exposure
20.5 Antepartum Prevention
20.5.1 Antiretroviral Drugs
20.6 Monitoring
20.7 Intra-partum Prevention
20.7.1 Intra-partum Antiretroviral Treatment/Prophylaxis
20.7.2 Mode of Delivery
20.8 Postpartum Prevention
20.8.1 Maternal Follow Up
20.8.2 Neonatal Follow Up
20.8.3 Breastfeeding: Managing Breastfeeding Populations
20.9 Barriers to PMTCT
References
21: The Microbiome in HIV-Infected Children
21.1 Introduction
21.2 The Maternal Vaginal Microbiome and HIV Transmission
21.3 The Microbiome of the Gastrointestinal Tract (GIT)
21.4 The Oropharyngeal Microbiome
21.5 The Respiratory Tract Microbiome
21.6 The Microbiome and HIV Status, Ageing and Comorbidities
21.7 Probiotic and Prebiotic Use in HIV-Infected Patients
21.8 The Effect of Anti-retroviral Agents (ARV’s) on the Microbiome
21.9 The Microbiome of HIV-Exposed Uninfected (HEU) Infants
21.10 Conclusion
References
22: Palliative Care for Children Living with HIV Infection
22.1 Introduction
22.2 What Is Palliative Care?
22.3 What Is Paediatric Palliative Care?
22.4 Physical Aspects in Palliative Care
22.4.1 Pain
22.4.1.1 Assessment of Pain in Children
FLACC Scale for Preverbal Children
22.4.1.2 Management of Pain
Note on the Use of Morphine
22.4.2 Dyspnoea
22.5 Psychological and Social Aspects in Palliative Care
22.5.1 Problems Associated with a Chronic Illness
22.5.2 Problems Associated with HIV Infection Itself
22.5.3 Approach to Management
22.6 Spiritual and Cultural Aspects of Palliative Care
22.6.1 Assessment and Management of Spirituality
22.7 Terminal Care
22.7.1 Recognising the ‘End’ Is Coming
22.7.2 Hospice Care
22.7.3 Advance Care Planning
22.7.4 Making the Decision to Stop Antiretroviral Medication
22.7.5 Symptoms at the End of Life
22.7.5.1 Pain at the End of Life
22.7.5.2 The Death Rattle
Management
22.7.5.3 Terminal Agitation
Management
22.8 Conclusion
References
23: Ethical, Legal, and Social Issues
23.1 Introduction
23.2 Ethical Norms and Values
23.2.1 The Four Principles Approach
23.2.2 Core Values in Healthcare Practice
23.2.3 Ubuntu and Traditional African Communalism
23.3 Human Rights Protections
23.3.1 International Human Rights Protections
23.3.2 Regional Human Rights Protections
23.3.3 South African Human Rights Protections
23.4 HIV Testing
23.4.1 Informed Consent
23.4.2 Pre-test and Post-test Counselling
23.4.3 Occupational Exposure to a Child’s Body Fluids
23.5 Disclosure
23.5.1 Confidentiality and Disclosure of a Child’s HIV Status
23.5.2 Disclosure of Status to Children
23.6 Mandatory Reporting of Abuse
23.7 Conclusion
References
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Raziya Bobat   Editor

HIV Infection in Children and Adolescents

HIV Infection in Children and Adolescents

Raziya Bobat Editor

HIV Infection in Children and Adolescents

Editor Raziya Bobat Department of Paediatrics and Child Health University of KwaZulu-Natal Durban KwaZulu-Natal South Africa

ISBN 978-3-030-35432-9    ISBN 978-3-030-35433-6 (eBook) https://doi.org/10.1007/978-3-030-35433-6 © Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Foreword

This textbook is long overdue. A set of unfortunate circumstances, partly biological, partly historical, indelibly political, resulted in the province of Kwazulu-Natal (KZN) being the region which bore the heaviest burden of the HIV epidemic in South Africa. KZN is also the region in the country with few health resources to cope with the sheer floods of people infected with HIV. The indicators of poverty and human suffering are at their most pernicious in this province; man and nature, it seems, conspired to prepare the most receptive sites, for the spread of the HIV epidemic, here around eThekwini. So it is a particular pleasure and a sense of fulfilment for me to see one of my colleagues, Professor Raziya Bobat, leading this team of outstanding co-authors, all thoroughly tested through the exigencies of the darkest years of the AIDS epidemic here in our midst, to put together a highly informative textbook on children and HIV. Professor Bobat has been at the heart of the epidemic of HIV as it first appeared in Durban, in the late 1980s, and with little to impede its advance through our societies; she watched with frustration the spread and growth of this epidemic. The state was embroiled in its own mysterious cogitations on the source, treatment and outcome of one of the most dreadful epidemics to hit our shores. Antiretroviral drugs appeared much later having become a proven and effective means of prevention and treatment. Indeed, her presence at the largest public hospital in the province enabled her to utilize whatever patients, public and academic resources were available to record the initial appearance and the rapid spread of this treacherous virus. This textbook is the victory of science, and society over the frustration and even despair of this very debilitating experience. It is fitting to pay the highest respect and recognition to our little patients who bore their pain and suffering with fortitude. Raziya Bobat has succeeded in calling on some of the most resourceful and knowledgeable individuals in this region to share their discoveries of care and treatment, with the next generations and those who choose unselfish healthcare as their preferred contribution to relieve the suffering of children and their mothers and families. This new book on paediatric HIV infection will serve as a useful textbook on paediatric HIV infection, with a wide range of data and information on the subject. The list given below, of the 23 chapters covering the depth and width of paediatric HIV, conveys a fair idea of the material from epidemiology, pathogenesis and transmission to clinical manifestations, treatment and prevention. In addition, areas such as HIV and TB co-infection, opportunistic infections, v

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Foreword

immunization in HIV, HIV and the microbiome and special populations (neonates and adolescents) are covered. Individual chapters are contributed by expert authors. Numerous case reports are included providing the reader with a useful guide through all relevant topics in the field. In reviewing this book as objectively as is possible under the circumstances of my personal acquaintance with many of the authors, each chapter has a credible story to tell. I gave each chapter a rough estimate, a numerical score of fitness for purpose. I took this purpose to be the assimilation of knowledge, learning and education on one of the worst epidemics to cross the borders of South Africa; the type of data available in this book will be of immense value to those seeking more scientific information on HIV in the region: primary care health personnel, clinicians, nurses, laboratory technicians, policymakers, etc. indeed virtually anyone wanting to make sense of the origins and ravages of HIV in southern Africa, within the shadows of the whole continent and globally. My attempts at scoring the chapters were met by a solid wall of sameness! In the event, the scores were all within a very narrow range, implying a consistency which was gratifying. Even before I conducted this little assessment, I knew the standards were quite high. It is obvious to me that Raziya Bobat has chosen very carefully and that there is a wealth of talent in the country on HIV. The individuals who require a deeper level of knowledge will also not be disappointed; there are many references to guide the ardent seeker of HIV data. Prof H. M. Coovadia Director, MatCH (Maternal, Adolescent and Child Health) Institute, University of the Witwatersrand, South Africa Emeritus Professor of Paediatrics and Child Health, University of Kwazulu-Natal, South Africa Commissioner, National Planning Commission, The Presidency, Republic of South Africa

Contents

1 Introduction and Epidemiology����������������������������������������������������������������   1 Ashendri Pillay 2 Transmission and Immunopathogenesis��������������������������������������������������   7 Raziya Bobat and Ashendri Pillay 3 Diagnosis of HIV Infection in Children and Adolescents����������������������  15 Gayle Sherman and Ahmad Haeri Mazanderani 4 Clinical Manifestations������������������������������������������������������������������������������  23 Raziya Bobat 5 Cutaneous Manifestations of HIV in Children ��������������������������������������  31 Antoinette Chateau and Anisa Mosam 6 Respiratory Diseases Amongst HIV Infected Children��������������������������  55 Prakash Mohan Jeena 7 Gastrointestinal Tract��������������������������������������������������������������������������������  73 Sanjay G. Lala 8 HIV Related CNS Disorders in Children������������������������������������������������  89 Lawrence Mubaiwa 9 Cardiovascular Manifestation of Paediatric HIV Infection������������������ 103 Ebrahim GM Hoosen 10 Haematological Manifestations of HIV Infection ���������������������������������� 115 Yasmin Goga 11 Malignancies���������������������������������������������������������������������������������������������� 131 Rajendra Thejpal 12 HIV-Related Kidney Diseases ������������������������������������������������������������������ 143 Rajendra Bhimma 13 Rheumatological Manifestations of HIV Infection �������������������������������� 153 Kogielambal Chinniah

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Contents

14 Opportunistic Infections���������������������������������������������������������������������������� 165 Melissa Lawler and Fathima Naby 15 Tuberculosis and HIV in Children ���������������������������������������������������������� 181 Mark F. Cotton, Samantha Fry, and Shaun Barnabas 16 Care and Management of a Neonate Born to an HIV Positive Mother������������������������������������������������������������������������ 203 Radhika Singh 17 Adolescents with HIV Infection���������������������������������������������������������������� 223 Lee Fairlie 18 General Management�������������������������������������������������������������������������������� 237 Moherndran Archary 19 Antiretroviral Treatment�������������������������������������������������������������������������� 247 Moherndran Archary 20 Prevention of Mother to Child Transmission of HIV ���������������������������� 265 Kimesh L. Naidoo 21 The Microbiome in HIV-Infected Children�������������������������������������������� 285 Robin J. Green 22 Palliative Care for Children Living with HIV Infection������������������������ 297 Julia Ambler 23 Ethical, Legal, and Social Issues�������������������������������������������������������������� 309 Ames Dhai and Safia Mahomed

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Introduction and Epidemiology Ashendri Pillay

Abstract

Research into HIV/AIDS has set a new precedence in the global health arena. The gains achieved in determining the epidemiology and burden of disease, in both resource rich and limited countries cannot be overestimated. The epidemic had merged medical and public health fraternities into collaborations to expedite the implementation of HIV prevention programmes internationally. With a heartening decline in mother to child transmissions of HIV, emphasis may now be directed to improving the quality of lives in children and adolescents living with HIV. Keywords

Epidemiology · CALHIV · EMTCT · Continuum of care · Phylogenetics Disclosure

In a world divided by economic inequalities, political strife and religious beliefs, human immunodeficiency virus (HIV) resulting in acquired immune deficiency syndrome (AIDS), has unified a global commitment to eliminate its transmission and improve the quality of lives of children and adolescents living with HIV (CALHIV). Eventual elimination in the foreseeable, albeit distant future, would be the ultimate achievement in public health.

A. Pillay (*) Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, UKZN, Durban, South Africa e-mail: [email protected] © Springer Nature Switzerland AG 2020 R. Bobat (ed.), HIV Infection in Children and Adolescents, https://doi.org/10.1007/978-3-030-35433-6_1

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1.1

A. Pillay

History

Paediatric AIDS was first described in the early 1980s. A few cases of unexplained cellular immunodeficiency and opportunistic infections were reported in infants, in the United States of America (USA) [1]. Since then, it has culminated in Sub Saharan Africa (SSA) firmly establishing itself as the epicentre of the current HIV epidemic.

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Epidemiology and Burden of Disease

• There are an estimated 36 million people living with HIV/AIDS (PLHA) globally. • Approximately 1.8 million are children less than 15 years old. • In 2017 there were 7.2 million PLHA reportedly living in South Africa (SA). • Of these, 280,000 were children (0–14  years) living with HIV, only 58% of whom were accessing ART. • Of the 270,000 new HIV infections recorded in 2017  in SA, 13000 were children [2]. For a number of years, elimination of mother to child transmission (EMTCT) remained the cornerstone of clinical and public health research. Evidence from multi-centre, landmark studies in both resource limited and resource rich settings, has resulted in numerous national and international interventions being implemented to attempt to halt the spread of HIV. In May 2016, SA became one of the first African countries to implement the Universal Test and Treat (UTT) policy, in accordance with WHO guidelines on HIV treatment. The UNAIDS 90–90–90 strategy aims were to diagnose 90% of all HIV infected persons, provide ART for 90% of those diagnosed, and achieve virologic suppression in 90% of those treated, by 2020 [3]. To date a majority of the persons infected with HIV in SA are aware of their status. The percentage of infected persons accessing ART is lower and the percentage that have virologic suppression is even lower [2]. This highlights the deficiencies in HIV continuum of care (CoC) in our setting. Unless programmes and policies are more urgently instituted, attrition will continue in every step of the care cascade. South Africa’s National Strategic Plan (NSP) for HIV, tuberculosis and sexually transmitted infections (STI) for 2017–2022, was launched in 2017. The aims set out by the NSP were to eliminate HIV, TB and STIs as public health problems in 5 years [4]. The focus is on specific areas and populations within SA where the incidence and burden of disease was greatest. The aim is to implement sustainable interventions with measurable outcomes and strengthen the systems and processes to achieve these goals. The NSP identified groups of individuals who are at particularly high risk of acquiring HIV. This included women, adolescent girls, children and orphans [4].

1  Introduction and Epidemiology

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In 2016 the ‘Start Free, Stay Free’ initiative by UNAIDS and PEPFAR, attempted to more urgently address HIV prevention, treatment, care and support services to children, adolescents and young women. The prevalence of HIV in young women in SA is higher than that of men, of the same age group [5]. Young women and adolescent girls, in particular, contribute to the significant number of new HIV infections. There has been a noticeable decline in the number of new infections in children (0–14  years). More young people (15–24  years) and adolescents (10– 19 years) are becoming infected with HIV and dying from AIDS related deaths [5]. AIDS is now the leading cause of death in young people in Africa [2]. In 2017 more than 95% of pregnant women living with HIV in SA were accessing ART and more than 95% of babies born to mothers who were HIV positive had an early infant diagnosis (EID) [6]. With SA’s national in utero (IU) transmission rates estimated at