HIV/AID awareness by Dr PZ Buthelezi

Report
HIV/AID AWARENESS
BY DR PZ BUTHELEZI-MLAMBO
HIV AND AIDS
CHRONIC DISEASE CANNOT BE CURED BUT WELL MANAGE AND CONTROLLED ITS NOT LIFE DEATH
SENTENCE.
 Therefore having HIV does not mean
 DEFINITION: Human
Immune Deficiency Virus
(HIV) that attack the
Immune system, the body’s
natural defense system ie.
CD4 count without a strong
immune system the body has
trouble fighting off disease
 AIDS: the last stage of HIV
infection low number of
CD4 cells and get infections
or cancer that rarely occur
in healthy people
you have AIDS, even without treatment
it takes long time for HIV to progress to
AIDS, usually 10-12yrs. If HIV is
diagnosed before it becomes AIDS,
medicine can slow or stop the damage to
the immune system
 Difference: viral infection reduces
insidious and progressive loss of immune
function that eventually results in
opportunistic infection and malignancies
that used in define AIDS
 Prevalence: In 2008, HIV/AIDS was most
prevalent in the South African provinces
of KwaZulu-Natal (15.8% HIV-positive),
Mpumalanga (15.4% HIV-positive), Free
State (12.6% HIV-positive), and North
West (11.3% HIV-positive), while only
3.8% of the population was HIV-positive
in Western Cape
ROUTES OF TRANSMISSION
UNPROTECTED SEXUAL INTERCOURSE
BLOOD TRANSFUSION
SHARING OF NEEDLE OR INJECTION OR BLADES
ORGAN TRANSPLANTATION
MOTHER TO CHILD
CONTAMINATED BLOOD PRODUCTS
#note it is not transmitted by hugging, eating on same
plate toilet seat, coughing and sneezing
WHO- STAGING
3:Severe weight loss more than10%
STAGE 1:Asymptomatic STAGE
 Chronic diarrhea more than 1 month
 Persistent fever more than a month
Persistent generalized
 Persistent oral conditions
lymphadenopathy
 Oral hairy
STAGE 2:Moderate weight  Pulmonary tuberculosis
 Severe bacterial infections
loss more than 10%
 Unexplained anemia
STAGE 4:HIV wasting syndrome
Recurrent respiratory
 PCP
infections (sinusitis,
 Recurrent several bacterial Pneumonia
tonsillitis, otitis media)
 Chronic herpes simpler infection
 Oesophageal candidates
Herpes Zooster
 Extra pulmonary tuberculosis
 HIV Encephalopathy
Recurrent oral ulcers
 Stereptocal Meningitis
Popular pruritic eruptions  Lymphoma
 Infusive cervical cancer
Seborrhea dermatitis
 Nephropathy or Cardiomyopathy

Fungal nail infections
SIGNS AND SYMPTOMS
 Head: Fungal skin infection








meningitis
encephalopathy, stroke
eyes: herpes zoot results in blindness
Ears: discharging and lymphodes
Mouth gingivitis
Chest: pneumonia, TB,
Abd: chronic diarrhoea vomiting, cervical cancer, chronic STI/Ulcers
Legs: peripheral neuris
Skin: dermtaphy, dermatis
Blood:
DIAGNOSIS
 Only diagnosed by doctor by taking sample/bloods
 Pre- and post-test counselling
 Purpose of HIV testing is simply identify infected individuals, but
also to educate both zero positive and zero negative people
about prevention and limiting transmission of the virus
 Before taking blood consent form must be signed
 Bloods
 Elisa
 PCR
 CDD4 count
 Viral load
HIV MANAGEMENT

HIV TESTING IN CHILDEN
Children should be tested for HIV
infection
 All HIV exposed infants
 Children do with TB or have hoof TB
treatment
 Father or sibling with HIV infection
death/ death of mother, father, sibling
 Mothers HIV status is unknown and
her whereabouts are unknown
 Child breast fed or well nursed by
women of unknown or positive status
 Children and clinical feature of HIV
infection
 Children who have experienced or
breast risk of sexual assault
 Test:HIV antibody detective test(eg hiv elisa)-
 cannot distinguish between mother and
body antibioticsmmmmm HIV antibodies are
transferred via the placenta to the baby during
pregnancy so that all vertically exposed babies
will be born with HIV antibodies and will test
positive on antibody detectives test.
 The antibodies will remain in the babies’ blood
upto18 months ie HIV exposed. Then viral
detection test such as HIV DNA(detect HIV
gene humanly) PCR (detect 6 weeks is
required) to establish the infection status of
child.
 Therefore HIV exposed but uninfected child
will test PCR negative and HIV exposed
infected child will test PCR positive
 Viral load 10 000 copies/ml (4) is regarded as
confirmation of HIV infection if PCR is positive
HIV/AIDS MANAGEMENT
 Prevention is better than cure- zero infection new generation
PMTCT: All pregnant women look early before 14 weeks gestation

All first antenatal books must be seen on same day

Booking bloods include RPR, RH, HB, HIV

Folic acid, Vit C, calcium, should be given at first visit
 If women test negative at 1st anetal visit- retest 12 weeks after 1st HIV test and 32 weeks of gestation in labour,6
weeks post every 3 months while breast feeding thereafter annually
 If women test positive at first anental visitall women regardless of CD4 cell count will be initialed or fixed dose
drugs(FTC+TOF, EFV) on same day they are diagnosed HIV positive
Blood creatine and CD4 are done the same day the review on 7 days
 CD4 350 cell/mm
 CD4 count 350 continue with ARV for duration of pregnancy and for 1 week after gestation of breast feeding then
stop ARV
 If already on ARV and pregnant- check CD4 count,VC, .if virally suppressed continue with the
asses adherence the change to
Women diagnosed HIV positive during pregnancy intra
 Start NVP and TRUVIDA and 3 hrly AZT
 Start FDC as soon as possible if breast feeding
if not suppressed,
HIV/AIDS MANAGEMENT
All HIV exposed infants: NVP syrup for 6 weeks irrespective of feeding
 BW> 250g 1,5ml daily at same time everyday
 Sw< 250g 1ml daily
 PCR test at 6 weeks for all HIV
 If breast fed, repeat PCR test in 6 weeks after of breast
 Exclusive breast feed is recommended feeding
 18 months rapid HIV test done for all HIV expose

Criteria to start ARV
 All children 5yrs

3yrs(<10kg)

3yrs(10kg)

If 3yrs and exposed NVP for 6 weeks or longer infant or ABC+
Failed regime( 2nd lie regme)
 ABC+3FC+EFV/NVP  AZT+3TC+ LPV/M

HIV EXPOSED INFANTS
 Done for 6 weeks
 6 weeks must visit the doctos and clinics for immunization and PCR testing
cotooooooooooooo
 …………….. / 4kg from 6 weeks
 MVT include Vitamin A
 IPT( prevent TB since HIV infected children have high risk of acquiring
tubercolcese even HIV negative children 5yrs who are exposed to TB
causes reduce the risk of TB by 95%
 Breast feeding can result to post natal transmission anytime during
breastfed if child already PCR positive continue with it
 If PCR negative and continue with breast feed you must repeat HIV test
after 6 week of stopped breast feed
ANTI-RETROVIRAL THERAPY
 Clinical criteria: confirm HIV infection in children 1 year
 1-5yrs symptoms stage 25 or CD4 25%
 Recruit 2admission to hospital for HIV complication
 Social criteria: 1 care hiver who is able to supervise and advertise medication
 Disclosure to another adult living in the same house in exchange so may assist with ARV

 Doses of ARV in children depends on the weight gain(NVP dosage), if small dose are given
or poor adherence will result inresistance or failure where child CD4 count does notrise,
viral load becomes dectable
 Regimes

 2nd line regime: used following treatment failure
 AZT,SDI,ALII
 ABC.BTC, ALUU

copies despite good

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