2,992
回編集
差分
ナビゲーションに移動
検索に移動
編集の要約なし
{{TM menu}}
==why child health==
*children and young people are still large proportion in whole population
==IMCI Integrated Management of Childhood Illness==
[https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/child-health/integrated-management-of-childhood-illness/ Integrated Management of Childhood Illness (IMCI)]
==HIV in children==
===epidemiology===
*2.8 mil. amongst 38 mil. LHIV are children 0-19 y/o
*DRC in 2019
**333,778 LHIV
**14,546 pregnant PMTCT
**22,828 infants
===transmission===
*95% mother to child transmission (MTCT)
**intrauterin 6-7%
**prepartum 19%
**postnatal/breastfeeding 10%
**35% risk in total
**risk factor of MTCT
***high VL, low CD4, subtype C HIV 1, cracked nipples, prematurity, ...
*sexual abuse
*sex in adolescent
*blood transfusion
*cultural actions; scarification, circumcision, tattoos by unsteriled knives
===clinical features===
*no symptoms at birth
*no specific symptoms after birth:
**chronic or recurrent diarrhea
**pneumonia (PCP)
**oral thrush
**poor growth
**recurrent severe infection
**chronic parotitis
**bacterial infections
===diagnosis===
*very difficult because of passive maternal antibody up to 18 months of age
*HIV DNA, HIV RNA, P24 antigen
*2 positive virology test means definitive HIV infection
*1 positive virology test means presumed HIV infection
*in the absence of virology test result, based on clinical conditions
*should be confirmed by antibody test after 18 months of age
*refer diagnostic algorithm in the handout
===treatment===
*all infants irrespective of WHO Stages or CD4
*first line:ABC/3TC+DTG
===prophylaxis===
*HIV positive mother not under ART at birth or mother HIV diagnosed after delivery are high risk of MTCT
*HIV positive mother under ART at birth, refer algorithm on the handout
*NVP for exposed infants
*options for infant feeding by HIV infected mother, refer the handout
**cultures in such DRC make HIV infected mother difficult to choose exclusive formula feeding, because such mother usually lives with big family and HIV infected status would be secreted due to stigmatization
**exclusive formula feeding criteria: AFASS
==HIV-TB coinfection in children==
*early HIV infection: TB presentation same as HIV negative children
*late HIV infection: disseminated TB
*older children with HIV: TB same as adult
*diagnosis same as HIV negative children
*treatment
==injury, accident, disability in LMICs==
*treatment
**first-line drugs cross placenta but seemingly not harmful
**use same regimen as non-pregnant women, 2RHZE+4RH***but Z is not recommended in US
