Home page  |  Help  |  Clear
English  |  French
 Search  |  Categories  |  Titles A-Z  |  Countries  |  Compare countries  |  Index  
Full TOC
Expand Document
Expand Chapter
Preferences

close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
Open this folder and view contentsCHAPTER 6: HIV/AIDS AND PREGNANCY
close this folderCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
View the document7.1 Introduction
View the document7.2 HIV/AIDS Manifestations in Children
View the document7.3 Diagnosis of HIV infection in infants
View the document7.4 Management of infants born to HIV positive women
View the document7.5Care of HIV infected Children
Open this folder and view contents7.6 Clinical manifestations of paediatric HIV infection
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
Open this folder and view contentsCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
Open this folder and view contentsCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
Open this folder and view contentsCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
Open this folder and view contentsCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
Open this folder and view contentsCHAPTER 15: HIV/AIDS AND NUTRITION
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

7.2 HIV/AIDS Manifestations in Children

Children may develop persistent generalised lymphadenopathy, failure to thrive, weight loss, persistent fever, recurrent skin rashes, recurrent pneumonias, recurrent bacterial infections and septicaemia, meningitis and encephalitis, persistent diarrhoea, pulmonary lymphocytic infiltrations, chronic parotitis and less frequently malignancies, such as, Kaposi’s sarcoma and lymphomas. Children may also develop opportunistic infections, such as, Pneumocystis pneumonia, candidiasis, non-typhoid salmonelloses, cryptococcal meningitis, tuberculosis, herpes simplex virus infections, and varicella zoster infection.

Clinical signs and symptoms in children that should prompt suspicion and therefore further clinical and laboratory evaluation are elaborated in the national IMCI algorithm, and the WHO clinical stages for HIV exposed children as below;

Table 9.1: WHO PAEDIATRIC CLINICAL STAGING

For use in those 14 years or under with confirmed laboratory evidence of HIV infection by HIV Antibody where age >18 months, DNA or RNA virological testing for those age <18 months.

STAGE 1

Asymptomatic

Persistent generalized lymphadenopathy (PGL)

Hepatosplenomegaly

STAGE 2

Recurrent or chronic upper respiratory tract infections (otitis media, otorrhoea, sinusitis, 2 or more episodes in any 6 month period)

Papular pruritic eruptions

Herpes zoster (past or current episodes in last 2 years)

Recurrent oral ulcerations (2 or more episodes in 6 months)

Lineral gingival Erythema (LGE)

Angular chelitis

Parotid enlargement

Seborrhoeic dermatitis

Extensive Human papilloma virus infection or Molluscum infection

Fungal nail infections

STAGE 3

Unexplained moderate malnutrition3 not adequately responding to standard therapy

Unexplained persistent diarrhoea (more than 14 days)

Unexplained persistent fever (intermittent or constant, for longer than 1 month)

Oral candidiasis (outside neonatal period)

Oral hairy leukoplakia

Uulmonary tuberculosis4

Severe recurrent presumed bacterial pneumonia (2 or more episodes in 6 months)

Acute necrotizing ulcerative gingivitis/periodontitis

Lymphoid interstitial pneumonitis (LIP)5

Unexplained Anaemia (<8gm/dl), neutropenia (<1,000/mm3) or thrombocytopenia (<50,000/mm3) for more than 1 month

Chronic HIV associated lung disease including brochiectasis

HIV related cardiomyopathy or HIV related nephropathy

STAGE 4

Conditions where a presumptive diagnosis can be made using clinical signs or simple investigations:

Unexplained severe wasting or severe malnutrition6 not adequately responding to standard therapy

Pneumocystic pneumonia

Recurrent severe presumed bacterial infections (2 or > episodes within one year e.g. empyema, pyomyositis, bone or joint infection, meningitis, but excluding pneumonia)

Chronic orolabial or cutaneous Herpes simplex infection (of more 1 month duration)

Extrapulmonary tuberculosis

Kaposi’s sarcoma

Oesophageal candida

CNS Toxoplasmosis (outside the neonatal period)

HIV encephalopathy

Conditions where confirmatory diagnostic testing is necessary:

Cryptococcal meningitis (or other extra pulmonary disease)

Disseminated non-tuberculous mycobacterial infection

Progressive multifocal leukoencephalopathy (PML)

Candida of trachea, bronchi or lungs

Cryptosporidiosis

CMV infection (CMV retinitis or infection of organ other than liver, spleen, or lymph nodes onset at age 1 month or more)

Any disseminated endemic mycosis (e.g. extra-pulmonary Histoplasmosis, Coccidiomycosis, Penicilliosis)

Isosporiasis

Recurrent non-typhoidal salmonella septicaemia (2 or>episodes in one year)

Acquired HIV related recto-vesico fistula

Cerebral or B cell non-Hodgkin’s Lymphoma

Table 9.2: WHO PAEDIATRIC CLINICAL STAGING

Presumptive diagnosis of clinical Stage 4 HIV infection in children less than eighteen months old where virological confirmation of infection is not available

In a HIV sero-positive infant less than 18 months symptomatic with 2 or more of following; oral thrush, +/- severe pneumonia, +/- severe wasting/malnutrition, +/- severe sepsis severe immuno-suppression should be suspected and ARV treatment is indicated

If CD4% is available it should be used to guide decision making

Other factors that support the diagnosis of clinical stage 4 HIV infection in an HIV sero-positive infant are recent maternal death or advanced HIV disease in mother.

to previous sectionto next section

Please provide your feedback English  |  French