HIV/AIDS
Maruti Lintang M. (13467)Liliani M. Tjikoe (20100310212)Khalifa Rahmani Putri (20100310135)HIV/AIDSEpidemiologyThe World Health Organization (WHO) estimated that in 2009, 2.5 million children worldwide were living with HIV-1 infection, 90% of who were from Sub-Saharan Africa. While between 2004 and 2009 the global number of children born with HIV decreased by 24% and deaths from AIDS-related illnesses among children 1 mo, hepatitis, recurrent (HSV) stomatitis, HSV esophagitis, HSV pneumonitis, disseminated varicella (i.e., with visceral involvement), cardiomegaly, or nephropathy .Category C (severe symptoms) includes childrenWith opportunistic infections (e.g. esophageal or lower respiratory tract candidiasis, cryptosporidiosis (>1 mo), disseminated mycobacterial or cytomegalovirus infection, Pneumocystis pneumonia, or cerebral toxoplasmosis [onset >1 mo of age]), recurrent bacterial infections (sepsis, meningitis, pneumonia), encephalopathy, malignancies, and severe weight loss.
DiagnosisAll infants born to HIV-infected mothers test antibody-positive at birth because of passive transfer of maternal HIV antibody across the placenta during gestation. Most uninfected infants without ongoing exposure (i.e., who are not breast-fed) lose maternal antibody between 6 and 12 mo of age and are known as seroreverters. Because a small proportion of uninfected infants continue to test HIV antibody positive for up to 18 mo of age, positive IgG antibody tests, including the rapid tests, cannot be used to make a definitive diagnosis of HIV infection in infants younger than this age. The presence of IgA or IgM anti-HIV in the infants circulation can indicate HIV infection, because these immunoglobulin classes do not cross the placenta; however, IgA and IgM anti-HIV assays have been both insensitive and nonspecific and therefore are not valuable for clinical use. In any child >18 mo of age, demonstration of IgG antibody to HIV by a repeatedly reactive enzyme immunoassay (EIA) and confirmatory.Western blot test establishes the diagnosis of HIV infection. Breast-fed infants should have antibody testing performed 12 wk following cessation of breast-feeding to identify those who became infected at the end of lactation by the HIV-infected mother. Certain diseases (e.g., syphilis, autoimmune diseases) may cause false-positive or indeterminate results. In such cases specific viral diagnostic tests (see later) have to be done.DiagnosisSeveral rapid HIV tests are currently available with sensitivity and specificity better than those of the standard EIA. Many of these new tests require only a single step that allows test results to be reported within less than half an hour. Viral diagnostic assays, such as HIV DNA or RNA PCR or HIV culture, are considerably more useful in young infants, allowing a definitive diagnosis in most infected infants by 1-6 moof age (Table 268-4). By 3-4 mo of age, the HIV culture and/or PCR identifies all infected infants.DiagnosisSeveral rapid HIV tests are currently available with sensitivity and specificity better than those of the standard EIA. Many of these new tests require only a single step that allows test results to be reported within less than half an hour. Viral diagnostic assays, such as HIV DNA or RNA PCR or HIV culture, are considerably more useful in young infants, allowing a definitive diagnosis in most infected infants by 1-6 moof age (Table 268-4). By 3-4 mo of age, the HIV culture and/or PCR identifies all infected infants.Diagnosis
Viral diagnostic testing should be performed within the 1st12-24 hr of life. Almost 40% of HIV-infected children can be identified at this time.Diagnosis
