Transcript Pediatric HIV/AIDS - Oklahoma State University–Stillwater

Pediatric HIV/AIDS
Nikki Dieker
AIDS Statistics
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Today 40 million people are estimated to be
living with HIV/AIDS including 3 million
children
During 2001, AIDS caused the deaths of
roughly 3 million people including 580,000
children
95% of the people that have HIV live in the
developing world
CDC Division of
HIV/AIDS Prevention
HIV/AIDS Statistics Cont
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Half of the 5 million new infections in the past
year occurred among individuals between 15
and 24 years of age
In the United States one quarter of new
infections occur in youths age 13-21 at a rate
of one new infection every hour
Children’s Friends for Life
AIDS Orphans
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Includes children who have lost either their
father, mother, or both to AIDS
By 2010 there will be 25 million living AIDS
orphans
Earlier estimates put the number at 40 million,
but it does not take into account the 15 million
AIDS orphans that will die in the next 8 years
UNICEF and UNAIDS
Mother to Infant Transmission
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Without interventions 35% of infants born to
HIV-positive mothers will contract HIV
Of these:
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15-20% occur during pregnancy
50% occur during labor and delivery
33% occur during breastfeeding
The Breastfeeding Dilemma
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Infants can contract HIV through breastfeeding
In developing countries formula is often not
available or extremely expensive
If formula is available, clean water often is not
Diagnosis
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An infant less than 18 months of age is
considered HIV-infected if they are
seropositive, or were born to an HIV infected
mother and has positive results on two separate
HIV tests
An infant can be excluded by the
disappearance of anti-HIV antibody by 18
months of age (seroreversion)
Major Problems Associated with
HIV/AIDS
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Malnutrition
Growth failure
Developmental delays
Micronutrient deficiencies
Neurological problems
Opportunistic infections
Normal childhood illnesses are potentially
fatal
Problems Continued
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If you have a child with AIDS you generally
have a family with AIDS
Socioeconomic status
Access to medication
Malnutrition
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Impaired nutritional absorption
Increased nutritional requirements
Reduced food intake
Impaired Nutritional Absorption
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HIV-induced diarrhea
Dehydration
Lactose intolerance
Opportunistic infections
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Cryptosporidioses
Tuberculosis
Gastric acid hypersecretion
Drug interactions
Increased Nutritional Requirements
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Metabolic activity changes
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Alterations in the function of the GI tract
Alteration in their ability to use food efficiently
Increased use of body fat stores
Recurrent fevers and infections
Depletion of vitamin and mineral stores
Increased calorie needs
Reduced Food Intake
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Partially due to neurological involvement
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Abnormal swallowing mechanisms
Gastroesophageal reflux
Aspiration
Decrease in taste and appetite
Regression of eating skills
Oral lesions and HIV-specific gingivitis and gum
disease
Drug induced nausea, gastric irritation and drug
volume and schedules
Psychological problems such as depression
Neurological and Developmental
Problems
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Impaired brain growth
Progressive motor dysfunction
Loss or leveling out of developmental
milestones
Seizures
Strokes
Nutrient Deficiencies
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Vitamin A (18-50%)
Vitamin E (27%)
Vitamin C (7%)
Riboflavin (26%)
Vitamin B6 (53%)
Vitamin B12 (23%)
Copper (74%)
Zinc (50%)
Selenium (10%)
Nutritional Assessment
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Detailed diet history
Medication history
Anthropometric data
Evaluation of weight changes
Laboratory data
What can be done?
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Early culturally acceptable dietary intervention
may help avoid growth failure
Small frequent feedings
Nutrient supplementation
Soft-textured, moist foods, at room
temperature (casseroles, eggs, pasta, and gravy
on meats)
Fluids may be tolerated better through a straw
What can be done?
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A tolerable anti-HIV regimen including a
combination of three different medications, two
reverse transcriptase inhibitors and a protease
inhibitor can cause weight gain, improved mental
functioning and a longer life
Aggressive treatment of opportunistic infections can
prevent the deterioration of nutritional status
Estimate energy needs using a Metabolic Cart, RDA
tables or the Bentler and Stannish formula for
catchup growth
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May be up to 200 kcal/kg and 4g protein/kg
What can be done?
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Evaluate feeding skills to see if tube feeding is
necessary or total parenteral nutrition is
necessary
For diarrhea:
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Lactaid milk and yogurt products
Soy milk
Soluble forms of fiber (oatmeal, rice, bananas,
applesauce)
Replace fluid loss with electrolyte solutions such
as Pedialyte
Tips for Caregivers
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Watch for any changes in your child’s behavior
Talk to your doctor before you give your child
any immunizations or booster shots
Plastic and washable toys are preferred
Food safely is vital
These children need a lot of love, don’t be
afraid to touch them
Reference
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Eley B, Hussey G. Nutrition and human
immunodeficiency virus in children. SA J Clin
Nutr. 1999;89:190-195.
Any Questions?