Paediatrics Adolescent Case: George

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PaediatricsAdolescent Case George

• Gareth Tudor Williams

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PaediatricsCase George

• 16 year old boy
• HIV diagnosed 2001
• On second regime
• TDF, ddI, Kaletra
• Poor compliance
• Last CD4 180
• Last VL 111,000
• Fever and cough

• Returned from Uganda 12 days ago
• Intermittent malaria prophylaxis and
  cotrimoxazole
• Missed some doses of ART
• Unaccompanied on ward
• Differential diagnosis?

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Born in UK. Returns to Uganda at 6 months. Mother
leaves after 3 years, lives with Father.
Pulmonary TB aged 9. Diagnosed HIVve. Returns to
UK age 10 to live with mother.
Resistance No PI / Low ddI, TdF / High NNRTI
Medication
ZDV / 3TC/ EFV
TDF / ddI / Kaletra
Dad Dies Goes to Uganda
Compliance difficult, Mum not supportive
Psychologist
Miserable MumSick
Social Worker Involved
Psychosocial
Neutropenia,herpes labialis
Chronic Cough
Absconds, poor attendance
Other Issues
Knowledge
Immune system
Virus
HIV
Log10VL
CD4
Puberty
Age
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PaediatricsCase George

• Investigations
• CRP 31
• WCC 5, neutrophil 1.2
• Malaria films negative
• Sputum no AFB, no PCP, oral flora only
• Blood culture ve
• VL 3919/ml
• CD4 260 (11)
• What treatment (HIV and acute)?

There is possible small volume adenopathy at the
left hilum. The lungs are otherwise clear.
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PaediatricsCase George

• Management
• Azithromycin 3 days, IV ceftriaxone 3 days
• Augmentin (co-amoxiclav) 5 more days
• Continue current HIV therapy and septrin
• Clinic next week (DNA)
• Probably continue current regime as it still
  works when he takes it