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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
 

7.5Care of HIV infected Children

Children should be assessed for symptoms related to HIV and the need for treatment and prophylaxis for opportunistic infections and other HIV related conditions. Baseline laboratory tests should be performed to establish viral and immunological status whenever possible. A complete medical and immunization history should be obtained, with particular emphasis on the suspected mode of HIV transmission, history of ARV exposure (pre-, intra-, and post-partum, and during breastfeeding) timing of HIV diagnosis and family members who are aware of the diagnosis.

Children with HIV should receive routine paediatric care and should be monitored for their HIV disease status. Children under the age of 1 year should be seen monthly; thereafter, they should be seen every three months. At each visit a complete physical examination should be done paying particular attention to signs commonly associated with HIV infection (e.g., adenopathy, hepatomegaly, splenomegaly). Growth and development should be evaluated and charted at all stages of development through adolescence. The need for medication should be reviewed based on history, physical exam and laboratory findings. Doses of prophylactic or treatment medications should be adjusted for growth, and compliance and tolerability be assessed at every visit. Medication plans (OI prophylaxis and ARV therapy) need to be discussed intensively with parents or guardians. It is advisable that one single person in the household is identified as the consistent careprovider responsible for dispensing treatment to the child. HIV related care needs of parents or guardians themselves need to be discussed and referred appropriately.

Disclosure of HIV status to the child should be discussed with the parents or guardians. The process of disclosure can be done over time. Whenever the counsellor feels that the child starts asking questions about the disease and indicate to feel isolated or special due to the disease, close coordination with guardian/parent is crucial. Overall, one can start mentioning to a 4 - 6 years old child that they have a chronic disease which requires regular clinic visits and even medicines every day. At about 8 - 10 years it is recommended to start raising the issue of HIV/AIDS in a caring and supportive environment. Before the early teen years they should know they have HIV/AIDS, how it is spread and how to stay healthy. It has been shown that when properly counselled, children can cope adequately with this. It is particularly important that adolescents be informed of their status and so can become active participants in their own care.

Children exposed to ARV should be closely monitored at every visit for signs of toxicity (i.e., clinical or laboratory indications). Adverse events should be properly documented and reported to the Ministry of Health.

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