TechnicalandOperationalissuesinPediatricHIVAIDS.pptVIP

LESSON OBJECTIVES To have an understanding of the magnitude of the problem of Paediatric AIDS Problems and challenges related to Paediatric HIV/AIDS Response to Paediatric AIDS with special response to India INTRODUCTION HIV is the greatest health crisis the world faces today. Estimated 40million people living with HIV 2.7 million children under 15 years are estimated to be infected with HIV Global Scenario HIV is the greatest health crisis the world faces today. Estimated 40 million people living with HIV 2.7 million children under 15 years are estimated to be infected with HIV 570,000 children died of AIDS in 2005 Children account for 18% of the 3.1 million AIDS deaths Only 40,000 or 4% of the approximately one million people now on treatment are children. Indian Scenario Estimated 202,000 children affected by HIV/AIDS. New cohort of approximately 50-60,000 HIV infected infants is added every year Less than 10% of HIV-positive expectant mothers are benefiting from ARV prophylaxis Aetiology Caused by the Human Immunodefiency virus Types I and II Type I - Worldwide Type II - Common in West African Transmission Majority 90% infected children acquire the infection through MTCT This occurs during pregnancy, delivery and breastfeeding In absence of any intervention, the risk of MTCT is 15 – 30% in non breast feeding populations Breastfeeding increases the risk by 5 – 20% to a total of 20 – 45%. MTCT rates are 5% in US and Europe with access of appropriate treatment In utero 25 – 45% Intrapartum 65 – 70% - most rapid course Postpartum 12 – 15% Other Means of Transmission Blood transfusions, blood products and organ/tissue transplants Contaminated needles Scarification marks ? Sexual intercourse Factors Affecting MTCT Maternal High maternal HIV RNA level Low maternal CD4+ T-lymphocyte count Chorioamnionitis Maternal vitamin A deficiency and malnutrition Co exciting sexually transmitted disease Urea of antiretroviral therapy Clinical states of mother