HIV Infection in Children and Adolescents 3030354326, 9783030354329

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