1. PAEDIATRIC AIDS
¨     Acquired immunodeficiency Syndrome (AIDS) is caused by Human Immunodeficiency Virus type 1 and 2
¨     World wide problem, more so in developing Countries.
¨     Ever since the report of the first pediatric case in 1983, there has been an alarming increase in the incidence of disease
¨     WHO estimate of about 5 to 10 million children expected to be infected by the end of year 2000AD worldwide.

2. PAEDIATRIC AIDS
   HIV infection occurs by contact with infected cells in blood and body fluids.
T The predominant cells infected are CD4+ T lymphocytes, depletion of which causes immunodeficiency.

3. PAEDIATRIC AIDS ¨ EPIDEMIOLOGY
¨     Pediatric AIDS constitutes 2% of all HIV infected cases in developed countries as compared to 15-20% in developing countries
¨     In India, women and children constitute 50% of all HIV infected individuals
¨     The pediatric population at risk for HIV-1 infection are;
Ø     babies born to infected mothers,

4. PAEDIATRIC AIDS
  ¨ Ø     children given HIV-1 contaminated blood or blood products,
Ø     adolescents who acquire infection sexually or by use of intravenous drugs
¨     The rate of mother to child transmission (vertical) of HIV-1 evaluated epidemiolocally in several surveys, has varied from 13-42%, with 65% of newborns infected during last six weeks of pregnancy and at delivery. ,

5. PAEDIATRIC AIDS
  ¨ ¨     Postnatal transmission via breast feeding has been found to be 14%.
¨  In developing nations, the HIV-1 epidemic begun to reverse the gains in infant and childhood morbidity and mortality, previously realized through nutrition and vaccine programmes . ,

6. PAEDIATRIC AIDS ¨ ¨ VERTICAL TRANSMISSION OF HIV-1
¨     It is an important and unique aspect of pediatric AIDS
¨     HIV-1 may be transmitted to the infant during gestation (in utero), during delivery (intrapartum) or postpartum, through breast feeding. ,

7. PAEDIATRIC AIDS
  ¨ ¨ ¨   ¨     Factors which may increase rate of vertical transmission of HIV-1 are;-
1.   High viral load in the maternal circulation,
2.   Maternal seroconversion just before delivery,
3.   Vitamin A deficiency in mother,
4.   Vaginal delivery,
5.   Delivery before 34 weeks,
6.   Detectable p24 antigen in maternal serum,
7.   Absence of neutralizing antibodies in maternal serum,

8. PAEDIATRIC AIDS ¨ ¨ 8. Maternal CD4 count less than 700/cmm or the
CD4 + CD8+ ratio less than 0.6

9. PAEDIATRIC AIDS ¨ ¨ ETIOPATHOGENESIS
¨  HIV genome is single stranded RNA virus, 9.8 kb in size ¨ 

10. PAEDIATRIC AIDS
 ¨  HIV selectively binds to cells expressing CD4 molecule on their surface-primarily T4 lymphocytes (CD4+ cells)
 ¨  Acts by REVERSE TRANSCRIPTASE
 ¨  Cause intense viremia
 ¨  Following cellular and humoral response within 1 week to 3 months, viral load decreases- PHASE OF CLINICAL LATENCY
¨     Patient undergo gradual deterioration of immune system with depletion of CD4+ cells
 ¨     More prone for opportunistic infections ¨ 

11. PAEDIATRIC AIDS ¨ CLINICAL FEATURES
¨     Pattern of disease expression and progression is quite variable in HIV-1 infected children.
¨     percent develop profound immunodeficiency and AIDS defining illnesses before the first year of life and two thirds having more slowly progressive course from to 10 years.
¨     Age of onset of any sign of HIV-1 infection predicts length of survival. ¨ 

12. PAEDIATRIC AIDS
 ¨     Clinical manifestations are the result of multi-system involvement associated with chronic persistent viral infection and secondary immunodeficiency.
¨     Failure to thrive, unexplained persistent fever,hepatosplenomegaly, parotitis, persistent & invasive oral thrush, recurrent gastroenteritis, otitis media, lymphadenopathy are the common early and mild signs and symptoms.
¨    

13. PAEDIATRIC AIDS
 ¨     ¨     LIP-lymphoid intertial pneumonia, organ specific infections and dysfunctions, repeated severe bacterial infections, loss of developmental milestones, meningitis, encephalopathy, idiopathic thrombocytopenia are commonly seen.
¨     Any prolonged unexplained illness should raise a suspicion of HIV-1 infection
¨    

14. PAEDIATRIC AIDS ¨ ¨ OPPORTUNISTIC INFECTIONS
¨     Occur as CD4+ count declines.
¨     PNEUMOCYSTIS CARINII (PCP) is the most common and lethal opportunistic infection in pediatric population.
¨     ORAL CANDIDIASIS is the most common fungal infection, may involve oesophagus-vomiting,fever,dysphagia and anorexia
¨    

15. PAEDIATRIC AIDS
 ¨   ¨     INTERSTITIAL CRYPTOSPORIDIOSIS –severe chronic diarrhoea and malnutrition
¨     ATYPICAL MYCOBACTRIAL INFECTION with Mycobacterium avium intracellulare complex(MAC)
¨     TOXOPLASMA GONDII,
¨     HERPES SIMPLEX,VARICELLA ZOSTER, CMV,MEASLES
¨    

16. PAEDIATRIC AIDS DIAGNOSIS OF HIV-1 INFECTION IN CHILDREN
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17. PAEDIATRIC AIDS DIAGNOSIS OF HIV-1 INFECTION IN CHILDREN
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