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HIV / AIDSIN PEDIATRIC

Department of Pediatrics

Medical Faculty University of NorthSumatera

H. Adam Malik Hospital 1

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Introduction HIV : Human immunodefciency Virus AIDS : Acquired Immune Defciency

Syndrome is a collection osymptoms and inections in humansresulting rom the specifc damage to theimmune system/ defciency cellular

immune caused by HIV inection

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http://www.wrongdiagnosis.com/medical/human.htmhttp://www.wrongdiagnosis.com/organ/immune_system.htmhttp://www.wrongdiagnosis.com/organ/immune_system.htmhttp://www.wrongdiagnosis.com/medical/human.htm

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haracteri!ed :" reduction o the Helper #"lymphocytes " opportunistic inections and

" de$elopment o malignant neoplasms %irst case :&'(&) *SA adult

homose+sual

In the ,orld) - ()... death e$ery day & person e$ery &.

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Immunologic maniestation :

" Helper # 0 " Ig1 and IgA

" 2atural +iller cell 0 " 3acrophag : s+in test Anergi" #uberculin

" 3umps " Candida albicans

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4pidemiology

&'(5 oles+e) rubinstein andamman : AIDS in children in *SA Higher HIV inection in the

,orld : Arica especially Aricasub"sahara 67.8 population9

&'(( : southeast Asia " #hailandfrst report AIDS in children

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orld epidemiology HIV / AIDS untilDesember ;..< #otal 7.=5..=...

>&< year ;=5..=...2e, case : 7='..=...

>&< year ?..=...Dead caused by AIDS : 5=&..=...>&< year :

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Near 1.800 baby born HIV !" / #ay

De$e%o&'n( )o*n+ry , HIV +ran-'-'on r'-

+o )'%# 25 40 .

Co&reen-'$e &re$en+'$e +ran-'--'on , 10

Ine)+'on ,

n-ae -e7

ID In+ra $ena Dr*( -er "

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HIV 6@9 baby

HIV 6@9 mother : ;< " 7.8 HIV 6@9baby

De$elopment country : >

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National Epidemioloy H!"#A!DS $%&&'(

B- C=

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ES3 K ;..5 ";..< (

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13DEVELOPMENT OF HIV VIRUSDEVELOPMENT OF HIV VIRUS

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Helper ) $redHelper ) $red

colour( invaded *ycolour( invaded *ymany H!" virusesmany H!" viruses

$*lue colour($*lue colour(

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#ransmissionSeQual#ransusion

ID*Verticaltransmission

reasteedingFthers

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Incubation periode Adult : 3 month-antibody anti HIV (window periode)

Clinical manifestation : immediately - many years later

< year! "iremia can detected early life - year

#purtinistic infection : clinical manifestation in $

mo life

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linical maniestation Asymptomatic AIDS 3icroorganisme inection rom

en$ironment %ailure ti thri$e) ,eight loss) anemia)

reccurent e$er) limphadenopaty) and

hepatosplenomegaly Fportunistic inection

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AIDS defning illness

%ailure to thri$erolonged diare

rolonged e$erFral candidiasisulmonary tuberculosisneumonia

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Gaboratory eQamination 3any place in Indonesia

: linical maniestation and serologic 6@9: arents suspected HIV 6@9

Some place: linical maniestation and serologic 6@9 %&'

C*

a+arta: linical maniestation: Serologic) D7 and E E2A

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Screening

Abandoned babies/street childrenabies o mother ,ith high ris+ beha$iour6drug addicts/prostitutes/multiple seQ

partner/single"teenage or underage9abies o HIV positi$e motherSeQually abused children O children ,ithseQually transmitted disease

hildren recei$ing regular bloodtransusion/blood products e=g #halasemia

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o o, up sc e u e or n an s o n ec e

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o o, up sc e u e or n an s o n ec emother

+epeat as soon aspossi*le

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Mother H!" ,ve

P-+ of a*y at % /eeks $%01 ml venous*lood in

ED)A *ottle(% /eekly follo/ up /ith F- until ' /eeks start P-P prophyla2is at ' /eeks till H!"

statusresolved $-otrimo2a3ole 41& m#m%#day

)MP

iven once daily on 5 alternate days/eekly

P-+ ,ve P-+ ,ve

+epeat H!" P-+ at '/eeks of ae

,ve 6ve

!nfected +epeat H!" P-+ *et/een 76' months of ae

P-P prophyla2is up to 4%months $or for life if develop

P-P or lo/ -D7 for ae(A+) and follo/ up

Non !nfected

Stop -otrimo2a3ole

5 month F#U until 48 months

Ensure that the *a*y9s H!" !:status is

neative *y 48 months

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3anagementFpportunistic inection : treatmentounseling : parents and / or amily

about nutrition) hygiene) ollo, upAEV indication 6 time R 9AEV : controlling

sychosocial support

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Frist line regimen :

AZT + 3TC + NVP/ EFV

d4T + 3TC + NVP/EFV

ABC + 3TC + NVP/ EFV

2525

Antiretroviral

2 NRTI + 1 NNRTI2 NRTI + 1 NNRTI

Second line regimen :

ABC +ddl +PI !PV/r "#"$ NFV%"#"$S&V/r 'il" BB (2) *g

Pedoman Nasional Terapi Antiretroviral. Departemen Kesehatan Republik IndonesiaDirektorat Jendral Pemberantasan Penakit !enular dan Penehatan "ingkungan#$%%&

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A;) ;idovudine

5)- "#r Sa?uinavir#ritonavir

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2

RNARNA

ReverseReverse

transcriptasetranscriptase

ProteaseProtease

DNADNA

NucleusNucleus

Protease

inhiitorsReverse transcriptase inhiitors!

NRTI "nucleosi#es$ nucleoti#es%

NNRTI

EntryInhibitors:

Fusion, CD4, CCR5

CXCR4

Tar(e+- o HIV Tera&y

HIV

Integrase

Inhibitors

CD4! TCe%%

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3## Inter$entionpattern

PMTCT (Prevention o Mother HIV toChild Transmission)

re$ent mother / candidate rom HIV in=I HIV 6@9) pre$ent unplanningpregnancy

re$ent transmission 6 AEV) S) AEVbaby) no breasteeding 9are and support

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re$entionDeli$ery O Inant 2ursing

All equipment used during deli$ery should be cleaned O sterilised

ord blood sample collected using a syringe Oneedle

2ursery1lo$es must be ,orn#hermometer must be o indi$idual use O suctioncatheter should be o single useDisposable diapersashed o the contact ,ith body secretionAll sharp according to the ministry o healthguidelines

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ircumcision lo,er the incidence o HIV C.8 accordingto HF= 3illions o people in the ,orld could be sa$ed

rom HIV by this method=

arber O circumcision equipments must be cleaned beoreused

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3illennium De$elopment 1oals 63D19

;D NT= ;ENA;@ATAN SE>A;@AT

>A;@ATNBA 2015

DI TANDATAN

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3D1 T

TAN ,

;E;@ERANTAS =E;IS=INAN =E>APARAN;ENCAPAI PENDIDI=AN DASAR NT= SE;A

;END?R?N< =ESETARAAN ENDER

PE;@ERDABAAN PERE;PAN

;ENRN=AN ANAINNBA;ENA;IN =E@ER>AN

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%FE #H4 %IES# #I34 HIV IS E4FE#4D I2%FE #H4 %IES# #I34 HIV IS E4FE#4D I224S44U &'(5 I2 *2I#4D S#A#4S F%24S44U &'(5 I2 *2I#4D S#A#4S F%

A34EIA AS A 3S#4EIF*S DIS4AS4A34EIA AS A 3S#4EIF*S DIS4AS4

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EF"$Efaviren3(0N"P$Nevirapine(

A- $A*acavir(0 ddl$Didanosine(0 5)-$"#r$Sa?uinavir#ritonavir(0+)" r +itonavir

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3

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EA#A"EA#A GH FA# 1DI3AUA2 42D4EI#A HIVW &. *#IE FA# #DD:" 5 3AA3 AEV ;Q/hr

" 4241AHA2 ;Q/hr

" A2#I A3*E 5Q/hr" A2#IIE4#IU ;"5Q/hr

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39TERAPI METHADOE !AAT II TER!EDIA DI R! ADAM MA"I#