HIV pada Anak

The UN Interagency task team has a four pronged strategy:

2. Prevent

unintended pregnancies

3. Prevent transmission from an HIVinfected woman to her infant

1. Primary HIV prevention in parents to be 4. Care and support

100 pregnant HIV positive women

On average 35 babies will be infected with HIV

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

Influences on the risk of transmission cont Factors related to labour and delivery:

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

Courtesy of Wendy Holmes

Influences on the risk of transmission cont Factors related to breastfeeding:

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

Courtesy of Wendy Holmes

Stadium klinis HIV pada anak

Stadium

klinis I : 1. Asimtomatik 2. Limfadenopati generalisata klinis II : 1. Diare kronik > 30 hr tanpa E yang jelas 2. Kandidiasis persisten atau berulang 3. BB (-) atau gagal tumbuh tanpa E yg jelas. 4. Demam persisten > 30 hr tanpa E yg jelas. 5. Infeksi bakteri berulang yg berat.

Stadium

Stadium

1. 2. 3. 4. 5.

klinis III : Infeksi oportunistik Gagal tumbuh yg berat (wasting) tanpa E yg jelas. Ensefalopati yg progresif. Keganasan. Sepsis atau meningitis berulang.

Obat Antiretroviral (ARV) Golongan : Nucleoside RTI : 1. Abacavir (ABC) 2. Didanosine (ddl) 3. Lamivudine (3TC) 4. Stavudine (d4T) 5. Zidovudine (ZDV / AZT)

 Nucleotide

RTI Tenofovir (TDF) Non-nucleoside RTI 1. Efavirenz (EFV) 2. Nevirapine (NVP) Protease inhibitors 1. Indinavir/ritonavir (IDV/r) 2. Lopinavir/ritonavir (LPV/r) 3. Nelfinavir (NFV) 4. Saquinavir/ritonavir (SQV/r) 5. Ritonavir (RTV,r)

Rejimen ARV lini-pertama :

d4T atau AZT + 3TC + NVP atau EFV Catatan : - Bila umur < 3 th atau BB < 10 kg : NVP - Bila umur > 3 th atau BB > 10 kg : NVP/EFV

Rejimen ARV lini-kedua : ABC + ddl + LPV/r atau NFV,atau SQV/r bila BB > 25 kg

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