HIV Pada Anak

HIV pada AnakHIV pada Anak

3. Prevent transmission from an HIV-infected woman to her infant

2. Prevent

unintended pregnancies

1. Primary HIV prevention in parents to be

4. Care and support

The UN Interagency task team has a four pronged strategy:

100 pregnant HI V positive women On average 35 babies will be infected with HI V

About 7 become infected during the pregnancy

About 15 become infected at the time of delivery

About 13 become infected through breastfeeding – most in the early weeks

Courtesy of Wendy Holmes

Influences on the risk of transmission cont…

Factors related to maternal health:

The risk is higher when: the placenta and amniotic fluid are infected

there is poor maternal nutrition, especially micronutrient deficiencies

the mother has a sexually transmitted infection

a baby is born prematurely, before 34 weeks gestation

interventions such as artificial rupture of membranes, and foetal scalp electrodes, increase risk

episiotomy may increase risk and is rarely needed

elective caesarean section reduces

risk

blood transfusion increases risk – especially when blood is not screened

Factors related to labour and delivery:

Influences on the risk of transmission cont…

Courtesy of Wendy Holmes

Influences on the risk of transmission cont…

Exclusive breastfeeding (nothing by mouth except breast milk) has a lower risk

Breast problems such as cracked nipples, mastitis and breast abscess increase risk

Oral problems in the baby, such as thrush and ulcers, increase the risk

Risk higher with high viral load – soon after infection with HIV; again when mother develops HIV-related illness

Cumulative risk throughout duration of breastfeeding

Factors related to breastfeeding:

Courtesy of Wendy Holmes

Stadium klinis HIV pada anakStadium klinis HIV pada anak Stadium klinis I :Stadium klinis I :

1. Asimtomatik1. Asimtomatik2. Limfadenopati generalisata2. Limfadenopati generalisata

Stadium klinis II :Stadium klinis II :1. Diare kronik > 30 hr tanpa E yang jelas1. Diare kronik > 30 hr tanpa E yang jelas2. Kandidiasis persisten atau berulang2. Kandidiasis persisten atau berulang3. BB (-) atau gagal tumbuh tanpa E yg jelas.3. BB (-) atau gagal tumbuh tanpa E yg jelas.4. Demam persisten > 30 hr tanpa E yg jelas.4. Demam persisten > 30 hr tanpa E yg jelas.5. Infeksi bakteri berulang yg berat.5. Infeksi bakteri berulang yg berat.

Stadium klinis III :Stadium klinis III :

1. 1. Infeksi oportunistikInfeksi oportunistik

2. 2. Gagal tumbuh yg berat (wasting) Gagal tumbuh yg berat (wasting) tanpa tanpa E yg jelas.E yg jelas.

3. 3. Ensefalopati yg progresif.Ensefalopati yg progresif.

4. 4. Keganasan.Keganasan.

5. 5. Sepsis atau meningitis berulang.Sepsis atau meningitis berulang.

Obat Antiretroviral (ARV)Obat Antiretroviral (ARV)

Golongan :Golongan :Nucleoside RTI :Nucleoside RTI :

1. Abacavir (ABC)1. Abacavir (ABC)

2. Didanosine (ddl)2. Didanosine (ddl)

3. Lamivudine (3TC)3. Lamivudine (3TC)

4. Stavudine (d4T)4. Stavudine (d4T)

5. Zidovudine (ZDV / AZT)5. Zidovudine (ZDV / AZT)

Nucleotide RTINucleotide RTI

Tenofovir (TDF)Tenofovir (TDF) Non-nucleoside RTINon-nucleoside RTI

1. Efavirenz (EFV)1. Efavirenz (EFV)

2. Nevirapine (NVP)2. Nevirapine (NVP) Protease inhibitorsProtease inhibitors

1. Indinavir/ritonavir (IDV/r)1. Indinavir/ritonavir (IDV/r)

2. Lopinavir/ritonavir (LPV/r)2. Lopinavir/ritonavir (LPV/r)

3. Nelfinavir (NFV)3. Nelfinavir (NFV)

4. Saquinavir/ritonavir (SQV/r)4. Saquinavir/ritonavir (SQV/r)

5. Ritonavir (RTV,r)5. Ritonavir (RTV,r)

Rejimen ARV lini-pertama :Rejimen ARV lini-pertama :

d4T atau AZT + 3TC + NVP atau EFVd4T atau AZT + 3TC + NVP atau EFV

Catatan :Catatan :- Bila umur < 3 th atau BB < 10 kg : NVPBila umur < 3 th atau BB < 10 kg : NVP- Bila umur > 3 th atau BB > 10 kg : Bila umur > 3 th atau BB > 10 kg :

NVP/EFVNVP/EFV

Rejimen ARV lini-kedua :Rejimen ARV lini-kedua :

ABC + ddl + LPV/r atau NFV,atau SQV/r ABC + ddl + LPV/r atau NFV,atau SQV/r bila BB > 25 kgbila BB > 25 kg

Terima KasihTerima Kasih