Pediatric HIV/AIDSPediatric HIV/AIDS

Nikki DiekerNikki Dieker

AIDS StatisticsAIDS Statistics

Today 40 million people are estimated to be Today 40 million people are estimated to be living with HIV/AIDS including 3 million living with HIV/AIDS including 3 million childrenchildren

During 2001, AIDS caused the deaths of During 2001, AIDS caused the deaths of roughly 3 million people including 580,000 roughly 3 million people including 580,000 childrenchildren

95% of the people that have HIV live in the 95% of the people that have HIV live in the developing worlddeveloping world

CDC Division of HIV/AIDS Prevention

HIV/AIDS Statistics ContHIV/AIDS Statistics Cont

Half of the 5 million new infections in the past Half of the 5 million new infections in the past year occurred among individuals between 15 year occurred among individuals between 15 and 24 years of ageand 24 years of age

In the United States one quarter of new In the United States one quarter of new infections occur in youths age 13-21 at a rate infections occur in youths age 13-21 at a rate of one new infection every hourof one new infection every hour

Children’s Friends for Life

AIDS OrphansAIDS Orphans

Includes children who have lost either their Includes children who have lost either their father, mother, or both to AIDSfather, mother, or both to AIDS

By 2010 there will be 25 million living AIDS By 2010 there will be 25 million living AIDS orphans orphans

Earlier estimates put the number at 40 million, Earlier estimates put the number at 40 million, but it does not take into account the 15 million but it does not take into account the 15 million AIDS orphans that will die in the next 8 yearsAIDS orphans that will die in the next 8 years

UNICEF and UNAIDS

Mother to Infant TransmissionMother to Infant Transmission

Without interventions 35% of infants born to Without interventions 35% of infants born to HIV-positive mothers will contract HIVHIV-positive mothers will contract HIV

Of these:Of these: 15-20% occur during pregnancy15-20% occur during pregnancy 50% occur during labor and delivery50% occur during labor and delivery 33% occur during breastfeeding33% occur during breastfeeding

The Breastfeeding DilemmaThe Breastfeeding Dilemma

Infants can contract HIV through Infants can contract HIV through breastfeedingbreastfeeding

In developing countries formula is often not In developing countries formula is often not available or extremely expensiveavailable or extremely expensive

If formula is available, clean water often is notIf formula is available, clean water often is not

DiagnosisDiagnosis

An infant less than 18 months of age is An infant less than 18 months of age is considered HIV-infected if they are considered HIV-infected if they are seropositive, or were born to an HIV infected seropositive, or were born to an HIV infected mother and has positive results on two mother and has positive results on two separate HIV testsseparate HIV tests

An infant can be excluded by the An infant can be excluded by the disappearance of anti-HIV antibody by 18 disappearance of anti-HIV antibody by 18 months of age (seroreversion)months of age (seroreversion)

Major Problems Associated with Major Problems Associated with HIV/AIDSHIV/AIDS

MalnutritionMalnutrition Growth failureGrowth failure Developmental delaysDevelopmental delays Micronutrient deficienciesMicronutrient deficiencies Neurological problemsNeurological problems Opportunistic infectionsOpportunistic infections Normal childhood illnesses are potentially Normal childhood illnesses are potentially

fatalfatal

Problems ContinuedProblems Continued

If you have a child with AIDS you generally If you have a child with AIDS you generally have a family with AIDShave a family with AIDS

Socioeconomic statusSocioeconomic status Access to medicationAccess to medication

MalnutritionMalnutrition

Impaired nutritional absorptionImpaired nutritional absorption Increased nutritional requirementsIncreased nutritional requirements Reduced food intakeReduced food intake

Impaired Nutritional AbsorptionImpaired Nutritional Absorption

HIV-induced diarrheaHIV-induced diarrhea DehydrationDehydration Lactose intoleranceLactose intolerance Opportunistic infectionsOpportunistic infections

CryptosporidiosesCryptosporidioses TuberculosisTuberculosis

Gastric acid hypersecretion Gastric acid hypersecretion Drug interactionsDrug interactions

Increased Nutritional RequirementsIncreased Nutritional Requirements

Metabolic activity changesMetabolic activity changes Alterations in the function of the GI tractAlterations in the function of the GI tract Alteration in their ability to use food efficientlyAlteration in their ability to use food efficiently Increased use of body fat storesIncreased use of body fat stores Recurrent fevers and infectionsRecurrent fevers and infections Depletion of vitamin and mineral storesDepletion of vitamin and mineral stores

Increased calorie needsIncreased calorie needs

Reduced Food IntakeReduced Food Intake

Partially due to neurological involvementPartially due to neurological involvement Abnormal swallowing mechanismsAbnormal swallowing mechanisms Gastroesophageal reflux Gastroesophageal reflux AspirationAspiration Decrease in taste and appetiteDecrease in taste and appetite Regression of eating skillsRegression of eating skills

Oral lesions and HIV-specific gingivitis and gum Oral lesions and HIV-specific gingivitis and gum diseasedisease

Drug induced nausea, gastric irritation and drug Drug induced nausea, gastric irritation and drug volume and schedulesvolume and schedules

Psychological problems such as depressionPsychological problems such as depression

Neurological and Developmental Neurological and Developmental ProblemsProblems

Impaired brain growthImpaired brain growth Progressive motor dysfunctionProgressive motor dysfunction Loss or leveling out of developmental Loss or leveling out of developmental

milestonesmilestones SeizuresSeizures Strokes Strokes

Nutrient DeficienciesNutrient Deficiencies

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

Nutritional AssessmentNutritional Assessment

Detailed diet historyDetailed diet history Medication historyMedication history Anthropometric dataAnthropometric data Evaluation of weight changesEvaluation of weight changes Laboratory dataLaboratory data

What can be done?What can be done?

Early culturally acceptable dietary intervention Early culturally acceptable dietary intervention may help avoid growth failuremay help avoid growth failure

Small frequent feedingsSmall frequent feedings Nutrient supplementationNutrient supplementation Soft-textured, moist foods, at room Soft-textured, moist foods, at room

temperature (casseroles, eggs, pasta, and gravy temperature (casseroles, eggs, pasta, and gravy on meats)on meats)

Fluids may be tolerated better through a strawFluids may be tolerated better through a straw

What can be done?What can be done?

A tolerable anti-HIV regimen including a combination A tolerable anti-HIV regimen including a combination of three different medications, two reverse transcriptase of three different medications, two reverse transcriptase inhibitors and a protease inhibitor can cause weight inhibitors and a protease inhibitor can cause weight gain, improved mental functioning and a longer lifegain, improved mental functioning and a longer life

Aggressive treatment of opportunistic infections can Aggressive treatment of opportunistic infections can prevent the deterioration of nutritional statusprevent the deterioration of nutritional status

Estimate energy needs using a Metabolic Cart, RDA Estimate energy needs using a Metabolic Cart, RDA tables or the tables or the Bentler and Stannish Bentler and Stannish formula for catchup formula for catchup growth growth May be up to 200 kcal/kg and 4g protein/kgMay be up to 200 kcal/kg and 4g protein/kg

What can be done?What can be done? Evaluate feeding skills to see if tube feeding is Evaluate feeding skills to see if tube feeding is

necessary or total parenteral nutrition is necessary or total parenteral nutrition is necessarynecessary

For diarrhea:For diarrhea: Lactaid milk and yogurt productsLactaid milk and yogurt products Soy milkSoy milk Soluble forms of fiber (oatmeal, rice, bananas, Soluble forms of fiber (oatmeal, rice, bananas,

applesauce)applesauce) Replace fluid loss with electrolyte solutions such Replace fluid loss with electrolyte solutions such

as Pedialyteas Pedialyte

Tips for CaregiversTips for Caregivers

Watch for any changes in your child’s Watch for any changes in your child’s behaviorbehavior

Talk to your doctor before you give your child Talk to your doctor before you give your child any immunizations or booster shotsany immunizations or booster shots

Plastic and washable toys are preferredPlastic and washable toys are preferred Food safely is vitalFood safely is vital These children need a lot of love, don’t be These children need a lot of love, don’t be

afraid to touch themafraid to touch them

ReferenceReference

Eley B, Hussey G. Nutrition and human Eley B, Hussey G. Nutrition and human immunodeficiency virus in children. immunodeficiency virus in children. SA J Clin SA J Clin Nutr. 1999;89:190-195.Nutr. 1999;89:190-195.

Any Questions?Any Questions?