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PREPARED BY:NISHA DULAL3RD YR BSC(N)
WHAT IS
H.I.V????
“Human Immunodeficiency
Virus”
H = Infects only Human beingsI = Immunodeficiency virus weakens the immune system and increases the risk of infectionV = Virus that attacks the body
WHAT IS AIDS?????
“Acquired Immune Deficiency Syndrome”
A = Acquired, not inheritedI = Weakens the Immune systemD = Creates a Deficiency of CD4+ cells in the immune systemS = Syndrome, or a group of illnesses taking place at the same time
DEFINITION
H.I.V (Human Immunodeficiency
Virus) is a unique type of virus (i.e. a
retrovirus) that invades the T- helper
cells (CD4 cells) in the body of the host
(defense mechanism of a person).
AIDS:acquired immunodeficiency
syndrome is a disease of the human
immune system caused by infection
with human immunodeficiency virus.In
children it is acquired perinatally or by
vertical –maternal-infant trasmission.
INCIDENCEAccording to WHO 2.3 million children below 15 years are
affected i.e 7.7% of the world population Globally 91% from vertical trasmission 5% from nosochrombial trasmission 4% from sexual abuse
CAUSES HIV virus From mother to featus i.e during pregnancy,labor
and delivery and breast feeding Blood trasfusion Sexual trasmission
RISK FACTOR Advanced maternal disease High maternal viral load Prolonged rupture of membranes Vaginal bleeding During breast feeding
EPIDEMIOLOGICAL FEATURES
AGENT FACTORS:
“Human Immunodeficiency virus”
There are two types of HIV.1. HIV-12. HIV-2
HIV-1 HIV-2
HIV-1 is more common worldwide.
HIV-1 is easily transmitted.
HIV-1 is pathogenic in nature
Duration of HIV-1 infection is quite long.
HIV-1 is commonly seen in India.
HIV-2 is found in West Africa, Mozambique, and Angola.
HIV-2 is less easily transmitted.
HIV-2 is less pathogenic.
Duration of HIV-2 infection is shorter .
HIV-2 is relatively rare and has not been reported from India.
SOURCE OF INFECTIONGreater concentration:• Blood• Semen• CSP
Lesser concentration:• Tears• Saliva• Urine• Breast-milk• Cervical and vaginal secretions
HOST FACTOR
S:
AGE
•Most cases in between 20-49 years.
•Rarely seen in childrens under 15 yrs.
SEX
•Seen in both males & females.
•Mostly in homosexual and bisexual mens.
HIGH RISK
•Male homosexuals & heterosexual partners.
•IV drug abusers, transfusion if infected blood
IMMUNOLOGY
•HIV virus infects and destroys T-helper cells.
•It results in reduced cellular immunity.
TIMING OF HIV TRASMISSION
• INTRAUTERINE
• INTRAPRATUM
• POSTPRATUM
PATHOPHYSIOLOGY
Viral DNA is transcribed into mRNA
Integrase inserts viral DNA into Host DNA
RNA transcribes DNA by enzyme Reverse Transcriptase
RNA enters the human cell
HIV virus binds to CD4 receptors on surface of T cells.
Due to etiological factors
PATHOPHYSIOLOGY (CONTINUE..)
Destruction of T- helper cells and immune response declines causing S/S.
Host cell is killed as viruses are released and budding process starts.
Polyprotein converts into genome n becomes permanent part of cell’s genetic structure.
mRNA is translated into protein – polyprotein
INCUBATION PERIODupto 6 years or more
CLINICAL FEATURESWHO clinical staging system for HIV
infection and related disease in children:
1. Asymptomatic stage(stage 1)2. Symptomatic stage(stage 2)3. AIDS(stage 3)
STAGE 1- ASYMPTOMATIC INFECTION
o Asmptomatico Persistant generalized lyphadectomy
SYMPTOMATIC STAGEo Unexplained chronic diarrhoeao Severe persistant or candidiasis outside the
neonatal peroido Weight loss or failure to thriveo Persistant fevero Recurrent severe bacterial infection
STAGE 3- AIDS Aids defining opportunistic infections Severe failure to thrive Progressive encephalopathy Malignancy Recurrent septicemia or meningitis
OPPURTUNIS
TIC ORGANISMS
IF CD4<500
Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposi’s sarcoma
HERPES SIMPLEX
HERPES ZOSTER
LEUKOPLAKIA
KAPOSI’S SARCOMA
IF CD4< 200
Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkin’s lymphoma
IF CD4 <50
Disseminated mycobacterium avium complex
(MAC) infection
Histoplasmosis
CMV retinitis
CNS lymphoma
Progressive multifocal leukoencephalopathy
HIV dementia
DIAGNOSIS CLINICAL:
The WHO clinical case defines pediatric
AIDS if the existence of at least two major
signs associated with at least one minor
sign in the absence of other known cases
of immunosupression such as cancer or
severe malnutrition or other recognized
etiologies.
•Weight loss (10% of body wt)•Chronic diarrhoea•Prolonged fever or intermittent fever for over a month
MAJOR SIGNS
•Persistent cough over a month•Generalized dermatitis•Recurrent herpes zoster•Oropharyngeal candidiasis•Generalised lymphadenopathy
MINOR
SIGNS
OTHER SIGNS AND SYMPTOMS Persistant thrush
Lymphadenopathy
Hepatosplenomegaly
Chronic diarrhoea
Parotid gland enlargement
Leukopenia
Hepatitis
Cardiomyopathy
Nephopathy
SCREENING TESTS
BLOOD DETECTION TEST
Enzyme Linked Immunosorbent Assay (ELISA)
• Screening test for HIV• Sensitivity > 99.9%
Western blot
• Confirmatory test• Specificity > 99.9% (when combined with ELISA)
Absolute CD4 lymphocyte count
• Predictor of HIV progression• Risk of opportunistic infections and AIDS when
<200
HIV viral load tests
• Best test for diagnosis of acute HIV infection• Correlates with disease progression and response
to HAART
TREATMENT
MANAGEMENT
There is no curative treatment of hiv aids.no vaccine are available for prevention.so children should be protected from contacting the hiv infection
Immunization can be given to hiv infected infant and children i.e are hepatitis b,polio vaccine,mmr,bcg etc
Plenty of fluid should be provided Nutriotional food shold be given
Medication like antidiarrhoeal,antipyretics,analgesics,antitursive drug shold be given.
Antiretroviral drugs is given when the child have signs of immunodepression or hiv associated symptomsi.e are didanosine,zalcilabine,staudine etc.these are used for prolongation of life.
Other drugs like prolease inhibitors,non nucleoside reverse transcriptase inhibitors is also given with antiretroviral combination therapy
PREVENTION Antiretroviral treatment with combination
therapy or post exposure prophylaxis to prevent hiv in children.
Vertical trasmission can be prevented by zidovudine prophylaxis to the infected pregant women antd to infant till 6 weeks of life.
Health education shold be given to people to avoidins blood brone hiv trasmission.
Provide specific prophylaxis for hiv manifestations.
Parent to child trasmission can be prevented by avoiding indiscrimate sexaul practices of adults.
Heticulous screening of blood and blood products should be done before blood trasfusion.
Sterilized syringe and needle should be used for immunization.
Aseptic techniques should be used during delivery.
Promoting community awareness of spread of hiv infection for unsafe practices.
NURSING DIAGNOSIS Risk for infections related to
immuodefiency rate. Alterd nutrition related to anorexia,pain in
abdomen. Diarrhoea and dehydration related to
enteric pathogens and infection. Alterd pain related to advanced hiv
diseases. Fear and anxiety related to diagnostic and
treatment procedures. Knowledge deficit regarding trasmission
of hiv infection.
ANY DOUBTS??