Pediatric HIV/AIDS

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Pediatric HIV/AIDS

• Nikki Dieker

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AIDS Statistics

• Today 40 million people are estimated to be
  living with HIV/AIDS including 3 million children
• During 2001, AIDS caused the deaths of roughly 3
  million people including 580,000 children
• 95 of the people that have HIV live in the
  developing world

CDC Division of HIV/AIDS Prevention
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HIV/AIDS Statistics Cont

• Half of the 5 million new infections in the past
  year occurred among individuals between 15 and 24
  years of age
• In the United States one quarter of new
  infections occur in youths age 13-21 at a rate of
  one new infection every hour

Childrens Friends for Life
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AIDS Orphans

• Includes children who have lost either their
  father, mother, or both to AIDS
• By 2010 there will be 25 million living AIDS
  orphans
• Earlier estimates put the number at 40 million,
  but it does not take into account the 15 million
  AIDS orphans that will die in the next 8 years

UNICEF and UNAIDS
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Mother to Infant Transmission

• Without interventions 35 of infants born to
  HIV-positive mothers will contract HIV
• Of these
• 15-20 occur during pregnancy
• 50 occur during labor and delivery
• 33 occur during breastfeeding

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The Breastfeeding Dilemma

• Infants can contract HIV through breastfeeding
• In developing countries formula is often not
  available or extremely expensive
• If formula is available, clean water often is not

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Diagnosis

• An infant less than 18 months of age is
  considered HIV-infected if they are seropositive,
  or were born to an HIV infected mother and has
  positive results on two separate HIV tests
• An infant can be excluded by the disappearance of
  anti-HIV antibody by 18 months of age
  (seroreversion)

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Major Problems Associated with HIV/AIDS

• Malnutrition
• Growth failure
• Developmental delays
• Micronutrient deficiencies
• Neurological problems
• Opportunistic infections
• Normal childhood illnesses are potentially fatal

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Problems Continued

• If you have a child with AIDS you generally have
  a family with AIDS
• Socioeconomic status
• Access to medication

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Malnutrition

• Impaired nutritional absorption
• Increased nutritional requirements
• Reduced food intake

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Impaired Nutritional Absorption

• HIV-induced diarrhea
• Dehydration
• Lactose intolerance
• Opportunistic infections
• Cryptosporidioses
• Tuberculosis
• Gastric acid hypersecretion
• Drug interactions

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Increased Nutritional Requirements

• Metabolic activity changes
• Alterations in the function of the GI tract
• Alteration in their ability to use food
  efficiently
• Increased use of body fat stores
• Recurrent fevers and infections
• Depletion of vitamin and mineral stores
• Increased calorie needs

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Reduced Food Intake

• Partially due to neurological involvement
• Abnormal swallowing mechanisms
• Gastroesophageal reflux
• Aspiration
• Decrease in taste and appetite
• Regression of eating skills
• Oral lesions and HIV-specific gingivitis and gum
  disease
• Drug induced nausea, gastric irritation and drug
  volume and schedules
• Psychological problems such as depression

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Neurological and Developmental Problems

• Impaired brain growth
• Progressive motor dysfunction
• Loss or leveling out of developmental milestones
• Seizures
• Strokes

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Nutrient Deficiencies

• Vitamin A (18-50)
• Vitamin E (27)
• Vitamin C (7)
• Riboflavin (26)
• Vitamin B6 (53)
• Vitamin B12 (23)
• Copper (74)
• Zinc (50)
• Selenium (10)

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Nutritional Assessment

• Detailed diet history
• Medication history
• Anthropometric data
• Evaluation of weight changes
• Laboratory data

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What can be done?

• Early culturally acceptable dietary intervention
  may help avoid growth failure
• Small frequent feedings
• Nutrient supplementation
• Soft-textured, moist foods, at room temperature
  (casseroles, eggs, pasta, and gravy on meats)
• Fluids may be tolerated better through a straw

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What can be done?

• A tolerable anti-HIV regimen including a
  combination of three different medications, two
  reverse transcriptase inhibitors and a protease
  inhibitor can cause weight gain, improved mental
  functioning and a longer life
• Aggressive treatment of opportunistic infections
  can prevent the deterioration of nutritional
  status
• Estimate energy needs using a Metabolic Cart, RDA
  tables or the Bentler and Stannish formula for
  catchup growth
• May be up to 200 kcal/kg and 4g protein/kg

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What can be done?

• Evaluate feeding skills to see if tube feeding is
  necessary or total parenteral nutrition is
  necessary
• For diarrhea
• Lactaid milk and yogurt products
• Soy milk
• Soluble forms of fiber (oatmeal, rice, bananas,
  applesauce)
• Replace fluid loss with electrolyte solutions
  such as Pedialyte

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Tips for Caregivers

• Watch for any changes in your childs behavior
• Talk to your doctor before you give your child
  any immunizations or booster shots
• Plastic and washable toys are preferred
• Food safely is vital
• These children need a lot of love, dont be
  afraid to touch them

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Reference

• Eley B, Hussey G. Nutrition and human
  immunodeficiency virus in children. SA J Clin
  Nutr. 199989190-195.

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Any Questions?