Index

Principles of Perinatal and Pediatric HIV/AIDS Mamatha M Lala, Rashid H Merchant

SECTION I: BASIC SCIENCES
1.1:Immunologic Considerations in the Management of HIV Infected Children
- Introduction
- Overview of HIV Structure and Life Cycle and Host Restriction Factors
- Viral Dynamics, HIV Disease Progression
- HIV and the Immune System
- The Innate Immune System During Pediatric HIV-1 Infection
- Management
- Immunologic Classification and Immune Monitoring
- Immune Reconstitution in HIV Infected Children
  - Childhood Immunizations in HIV Infected Children
- Specialized Laboratory Evaluation of HIV Infected Children
- Case Studies
- Summary
- Key Messages
1.2:Virology and Laboratory Diagnosis of HIV Infection in Infants and Children
- Introduction and Importance
- Rationale for Early Diagnosis: The Natural History of Untreated HIV Infection in Infants and Children
  - Rationale for Early Infant Diagnosis
  - Timing and Early Natural History of HIV Transmission from Mother to Child
- Methods for Diagnosis of HIV-1 Infection in Infants and Children
- Strategies for Diagnosis of HIV Exposed Infants
- Care to Ensure that Infected Infants are Promptly Treated
- Testing of the Older Child
- Pitfalls in the Diagnosis of HIV in Infants and Children
- Case Study
1.3:Natural History of HIV in Children
- Introduction
- HIV Progression in the First Year of Life
- HIV Progression after the First Year of Life
- Slow-Progressors—Late Presentation of HIV
- Survival to Adulthood
- Case Studies
- Key Messages
1.4:Pharmacotherapy of Pediatric HIV Infection
- Pediatric HIV Infection—Increasing Trends
- Goals of Therapy
- Life Cycle of HIV
- Overview of Antiretroviral Medications
- Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTIs/NtRTIs)6–11
- Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)6–10
- Protease Inhibitors (PIs)6–10
- Entry Inhibitors6–10
- Integrase Inhibitor6–10
- Pharmacological Considerations in Children
- Drug Interactions20
  - Pharmacokinetic Interactions
  - Pharmacodynamic Interactions
- Barriers to Treatment
- Future Treatment/Novel Therapies
SECTION II: CLINICAL MANIFESTATIONS OF HIV INFECTION IN CHILDREN
2.1:Clinical Manifestations of HIV/AIDS in Children: An Overview
- Clinical Classification of HIV Infected Children
- Clinical Manifestations
- Respiratory System
- Central Nervous System
- Gastrointestinal and Hepatobiliary System
- Cardiovascular System
- Renal System
- Skin
- Hematological System
- Growth, Nutrition and the Endocrine System
2.2:Dermatological Manifestations of HIV in Children
- Introduction
  - Infections and Infestations
  - Inflammatory Conditions
  - Tumors
  - HAART-related
- Herpes Simplex (Fig. 2.2.1)
- Varicella Zoster (Figs 2.2.2 and 2.2.3)
- Molluscum Contagiosum (Fig. 2.2.4)
- Verrucae (Figs 2.2.5 to 2.2.7)
- Scabies (Figs 2.2.8 and 2.2.9)
- Candidiasis (Fig. 2.2.10)
- Superficial Fungal Infection (Fig. 2.2.11)
- Pyoderma (Fig. 2.2.12)
- Papular Urticaria (Fig. 2.2.13)
- Tuberculosis (Figs 2.2.14 and 2.2.15)
- Systemic Fungal Infections
- Seborrheic Eczema (Figs 2.2.16 and 2.2.17)
- Papular Eruptions of HIV (Fig. 2.2.18)
- Drug Eruptions (Figs 2.2.19 and 2.2.20)
- Kaposi's Sarcoma (Figs 2.2.21 and 2.2.22)
  - HAART related
- Immune Reconstitution (Fig. 2.2.23)
- Conclusion
- Case Studies
- Answers
  - Additional Recommended Reading
2.3:Ocular Manifestations in Children with HIV
- Introduction
- Ocular Manifestations of Pediatric HIV Infection
- Cytomegalovirus Retinitis (Figs 2.3.1A to C)
  - Clinical Findings
  - Treatment (Figs 2.3.3A and B)
    - Initial Drug Treatment
- Necrotizing Herpetic Retinopathy13,14
- Toxoplasmosis 8,9,13–16 (Fig. 2.3.4)
  - Treatment
- Choroiditis
  - Pneumocystis
- Mycobacterial Disease (Fig. 2.3.5)
  - Clinical Manifestations
  - Treatment
- Fungal Infections
  - Cryptococcus
  - Treatment
- Spirochetal Infections
  - Treponema Pallidum
  - Treatment
- Bacterial Keratitis
  - Clinical Features
  - Treatment
- Herpes Zoster Ophthalmicus (Fig.2.3.6)
  - Treatment
- Molluscum Contagiosum8
  - Treatment
- Vasculopathy9,12
- Large Vessel Disease9,12
- Neoplasms
  - Squamous Cell Carcinoma of Conjunctiva9,15,16
  - Treatment
  - Kaposi's Sarcoma of the Eyelid and the Conjunctiva3,8,9
  - Treatment
  - Cutaneous and Conjunctival Lymphoma3
  - Treatment
- Other Manifestations
  - Keratoconjunctivitis Sicca (KCS)3
- Iatrogenic and Post-treatment Manifestations
  - Immune Recovery Uveitis3,9,12
- Retinal Detachment (Fig. 2.3.7)
- Drug-induced Uveitis3
- Stevens-Johnson Syndrome (SJS)3,9
- Conclusion
- Key Messages
2.4:HIV/AIDS: A Pediatric Dentistry Perspective
- Introduction
- Classification of Oral Lesions
- Oral Manifestation of HIV Infection
  - Orofacial Manifestations Associated with HIV Infection
- Candidiasis
  - Pseudomembranous Candidiasis
    - Presumptive Criteria44
    - Definitive Criteria44
  - Erythematous Candidiasis (Fig. 2.4.4)
    - Presumptive Criteria44
    - Definitive Criteria44
- Angular Cheilitis (Fig. 2.4.5)
- Herpes Simplex Virus Infections
- Gingival and Periodontal Lesions
- Linear Gingival Erythema (Figs 2.4.7A and B)
- Salivary Gland Disease
- Oral Ulceration
  - Recurrent Aphthous Ulcers (Fig. 2.4.9)
  - Minor Recurrent Aphthous Ulcers (Fig. 2.4.10)
    - Presumptive Criteria44
    - Definitive Criteria44
  - Major Recurrent Apthous Ulcers (Fig. 2.4.11)
    - Presumptive Criteria44
    - Definitive Criteria44
  - Herpetiform Recurrent Aphthous Ulcers
    - Presumptive Criteria44
    - Definitive Criteria44
- Bacterial Infections of Oral Tissues
- Periodontal Diseases
  - Necrotizing Ulcerative Gingivitis (NUG) (Fig. 2.4.12)
    - Presumptive Criteria44
    - Definitive Criteria44
  - Necrotizing Ulcerative Periodontitis (NUP) (Fig. 2.4.13)
    - Presumptive Criteria44
    - Definitive Criteria44
- Necrotizing Stomatitis (NS) (Fig. 2.4.14)
- Seborrheic Dermatitis
- Viral Infections
  - Cytomegalovirus (CMV) (Fig. 2.4.15)
    - Presumptive Criteria44
    - Definitive Criteria44
  - Human Papilloma Virus (HPV) (Fig. 2.4.16)
    - Presumptive Criteria44
    - Definitive Criteria44
  - Molluscum Contagiosum (Fig. 2.4.17)
    - Presumptive Criteria44
    - Definitive Criteria44
  - Herpes Zoster (Fig. 2.4.18)
    - Presumptive Criteria44
    - Definitive Criteria44
  - Varicella
    - Presumptive Criteria44
    - Definitive Criteria44
- Xerostomia (Fig. 2.4.19)
- Kaposi's Sarcoma (KS) and Non-Hodgkin's Lymphoma (Fig. 2.4.20)
- Oral Hairy Leukoplakia (Fig. 2.4.21)
- Tuberculosis-related Ulcers
- Cervical Lymphadenopathy
- Petechiae (Fig. 2.4.22)
- Dental Caries (Fig. 2.4.23)
- Importance of Orofacial Lesions in HIV Infection
- Oral Lesions as An Early Sign of HIV Infection
- Oral Lesions as a Predictor of Disease Progression
- Oral Lesions as Markers for Clinical Drug Trials
- Oral Lesions for Disease Classification
- Role of Dental Professionals
  - Dental Management of HIV Infected Children101
- Control of Cross Infection
- Conclusion
2.5:Neurological Manifestations of HIV in Children
- Introduction
- Epidemiology
- Pathophysiology
- Neurological Complications and Management
- Baseline Neurological Evaluation
- Specific Complications and their Management
  - HIV Encephalopathy
- Infections of the Central Nervous System
- Primary CNS Lymphoma
- HIV Related Neuropathy/Myopathy/Myelopathy
- Seizures
- Stroke
- Key Messages
2.6:Pulmonary Manifestations in Children with HIV
- Introduction
  - Epidemiology
- Pulmonary Tuberculosis
- Infection with Mycobacteria other than Tuberculosis (MOTT)
- Bacterial Pneumonias
- Pneumocystis Jerovecii Pneumonia
- Viral and Fungal Pneumonias
- Lymphoid Interstitial Pneumonitis (LIP)
- Immune Reconstitution Inflammatory Syndrome (IRIS)
- Bronchiectasis
- Chronic Respiratory Diseases
- Pulmonary Malignancies
- Acknowledgments
2.7:Cardiac Manifestations in HIV Infected Children
- Introduction
- Cardiac Involvement
- Cardiac Manifestations
- Dilated Cardiomyopathy and Myocarditis
- Pathophysiology
- Pericardial Disease
- Coronary Artery Disease
- Cardiac Involvement with Vertical Transmission
- Pulmonary Hypertension
- Cardiac Tumors
- Autonomic Dysfunction
- Endocarditis
- Arteriopathy
- Symptoms
  - Assessment
  - Blood Chemistry
- Treatment
- Summary
2.8:Hematological Aspects and Management of Pediatric HIV Disease
- Introduction
- Immune System
  - Bone Marrow in HIV Infection
  - Pathogenesis of Cytopenias
- Anemia
- Thrombocytopenia
- Neutropenia
- Coagulation Abnormalities
- Case Studies
2.9:Renal Disease in Pediatric HIV Infection
- Introduction
- HIV Associated Nephropathy (HIVAN)
- HIVICK and other Glomerulopathies Related to Immunological Abnormalities
- Acute Tubular Dysfunction with Electrolyte Fluid Abnormalities and/or Renal Failure Caused by Infections and Nephrotoxic Drugs
- Microangiopathies
- Others
  - UTI, Stones, Tumors, Comorbidities, Renal Infections
- Long Term Effects of HIV, HAART and Co-morbidity
- Use of Urinary Biomarkers
- Genetics and Pathophysiology
- Renal Replacement Therapy and Transplantation
- Case Studies
- Answers
- Answers
- Answers
- Key Messages
2.10:Gastrointestinal and Hepatobiliary Manifestations in Children with HIV
- Introduction
- Epidemiology
- Drug-induced Side-effects
- Upper GI Disease
- Diarrhea
- Hepatobiliary Disease
- Hepatitis
- Pancreatitis
- Key Messages
2.11:Growth/Development/Puberty in HIV Infected Children and Disorders of the Same
- Introduction
- Epidemiology
- Physiology of Human Growth and Development
- Physiology of Puberty and Adolescence
- Classification of Growth Disorders in HIV Infected Subjects
- Reproductive Health of Adolescent Girls Perinatally HIV Infected or with Behaviorally Acquired HIV Infection
- Pathogenesis of Impaired Growth
- The Role of Endocrine Dysfunctions
- Alterations in Gastrointestinal Function
  - Diarrheal Diseases and Malabsorption
- Pathogenesis of Impaired Sexual Maturation
- Conclusion and Future Developments
- Case Studies
- Key Messages
2.12:Malignancies Associated with Pediatric HIV Infection
- Introduction
- AIDS Defining Malignancies
- Non-AIDS-Defining Malignancies
  - Leiomyosarcomas
    - Overview
    - Clinical Manifestations
  - Hodgkin's Disease
2.13:Opportunistic Infections in HIV Infected Children
- Fungal Infections
- Viral Infections
- Mycobacterial Infections
- Parasitic Infections
- Case Studies
- Key Messages
2.14:HIV and Tuberculosis Co-infection in Children
- Epidemiology
- Etiology
- Pathogenesis
- Infection and Disease
- Clinical Presentation
- Case Report of LIP
- Diagnosis of Tuberculosis in HIV+ Children
- Treatment of Tuberculosis and Monitoring in HIV-TB Children
- The Role of Adjuvant Steroid Treatment
  - Immune Reconstitution Inflammatory Syndrome (IRIS)
- Immunoprophylaxis with BCG Vaccination
- Chemoprophylaxis
- Drug Resistant TB in Children
- Case Studies
- Key Messages
2.15:Hepatitis B Co-infection in HIV Infected Individuals with Special Reference to Children
- Introduction
- Epidemiology
  - Prevalence in India
  - Genotypes
- HIV and HBV Co-infection
  - Transmission
  - Clinical Presentation and Natural History
- Acute HBV Infection
- Chronic HBV Infection
- Management of Hep B and HIV
- Case Study
- Key Messages
2.16:Hepatitis C Co-infection in HIV Infected Individuals with Special Reference to Children
- Epidemiology
- HIV and Hepatitis C Co-infected Children
- Management of Concomitant HIV and Hepatitis C
- Case Study
- Key Messages47
2.17:Malaria and HIV Infection
- Severe Malaria
2.18:Immune Reconstitution Inflammatory Syndrome in Children
- Introduction
- Basic Pathophysiology
- Epidemiology
  - IRIS in Resource-limited Settings
- IRIS Case Definition
- Clinical Presentation and Diagnosis of Common IRIS Conditions
- Management Approaches to IRIS
- Prevention of IRIS
- Case Studies
2.19:The HIV Infected Child in the Emergency Department
- Introduction
- The Child with Unknown HIV Infection
- The HIV Infected Pediatric Patient in the Emergency Department
- Fever in the HIV Infected Child
- Gastrointestinal Problems in the HIV Infected Child
- Skin Problems in the HIV Infected Child
- Neurologic Problems in the HIV infected Child
- Cardiorespiratory Problems in the HIV Infected Child
- Other Opportunistic Infections in the Emergency Department11
- Antiretroviral Drug Related Problems in the Emergency Department10
- Case Studies
- Key Points
- Key Points
- Key Messages
SECTION III: WOMAN, NEWBORN AND HIV
3.1:A Guide to the Clinical Care of Pregnant Women with HIV
- Background
- Epidemiology of HIV in Pregnancy
- Pregnancy and Risks of Transmission
- Diagnosing HIV during Pregnancy
  - HIV Testing Issues
- Psychosocial Issues
- Health Seeking Behavior Issues
- Sexual Abuse in Pregnancy
- Effect of HIV Infection on Pregnancy
  - Effect of HIV on CD4 and HIV RNA Levels in Pregnancy
  - Effect of HIV on the Course and Outcome of Pregnancy
- Effect of Sexually Transmitted Infections (STIs) on HIV positive Pregnant Women
  - Rationale for a Genital Screen in Pregnancy
  - Syphilis in HIV Infected Pregnant Women
  - Genital Herpes Simplex Viral Infection (HSV) in Pregnancy
  - Human Papilloma Virus (HPV) and Cervical Dysplasia in Pregnancy
- AIDS Defining Illness in HIV Infected Pregnant Women
  - Candidiasis in Pregnancy
  - Pneumocystis Jirovecii Pneumonia (PCP)
  - Cytomegalovirus Infection
  - Mycobacterium Tuberculosis (TB)
  - Multidrug Resistant TB
  - Mycobacterium Avium Complex (MAC)
  - Cryptococcus Neoformans (CN)
  - Toxoplasma Gondii
- Associated Co-infections
  - Hepatitis B in HIV Infected Pregnant Women
  - Hepatitis C in HIV Infected Pregnant Women
- Immunization in Pregnancy
- Recommendations for the Use of Anti-retroviral Drugs in Pregnancy
- Medical Complications in HIV Positive Pregnant Women
  - Nausea and Vomiting
  - Bleeding in Pregnancy
  - Thromboembolism
  - Malaria in Pregnancy
  - Gestational Diabetes
  - Abnormal Liver Function Tests
  - Lactic Acidosis
  - Fetal Malformations
- Obstetric Complications in HIV Positive Pregnant Women
  - Spontaneous abortion
  - Stillbirth
  - Perinatal mortality
  - Infant mortality
  - Intrauterine growth retardation
  - Low birth weight (<2500 gm)
  - Pre-eclampsia
  - Oligohydramnios
  - Chorioamnionitis
  - Preterm delivery
  - Preterm Prelabor Rupture of Membranes in HIV Positive Women (PPROM)
  - Prolonged Pregnancy
- Management of Delivery
- Postpartum Care
- Management of the Neonate
- Contraception Advice
- Plan of Care
  - Antenatal Evaluation and Monitoring Principles
- Pharmacokinetics and Therapeutic Drug Monitoring (TDM) of Antiretrovirals in Pregnant Women
  - NRTIs
  - NNRTIs
  - Protease Inhibitors
- Pharmacokinetics of Antiretroviral Drugs in Breast Milk
3.2:Vertical Transmission of HIV: An Update
- Introduction
- Magnitude of the Problem
- Factors Affecting Transmission
- Interventions to Decrease Mother-to-Child Transmission of HIV
- Pregnancy in Women with HIV-2 Infection
3.3:Prevention of In Utero and Intrapartum HIV: Mother-to-Child Transmission: The Safety and Efficacy of Antiretroviral Therapy
- Introduction
- Risk Factors Associated with HIV Mother-to-child Transmission
  - Timing of Infection
  - HIV Viral Load
- Interventions to Reduce the Risk of HIV Mother-to-Child Transmission
- Conclusion
- Case Studies
- Key Messages
3.4:Care of a Child Born to a HIV Positive Mother
- Introduction
- Natural Course of HIV Infection in Infants
- When a Neonate is Born to a HIV Positive Mother the Following Steps are Taken
- Conclusion
3.5:Breastfeeding Issues in the Context of HIV
- Introduction
- 2007 WHO/UNICEF/UNAIDS Guidelines of HIV and Infant Feeding
- Four General Strategies have been Proposed to Reduce the Risk of Postpartum Breastfeeding HIV Transmission
- The Special Case of Feeding the HIV Infected Infant
- Newly released WHO/UNICEF/UNAIDS Guidelines— 30 November, 2009
- Conclusion
  - Discussion
  - Some Examples of Mothers who used HTEBM
- Key Messages
- Acknowledgments
3.6:Perinatal HIV and Tuberculosis Infection and Management
- Introduction
- Gender Differences
- Tuberculosis in Pregnancy
- Outcomes
  - Maternal Mortality
  - Obstetric Perinatal and Neonatal Outcomes
- Management of the Pregnant Woman with TB and HIV
- Multi Drug Resistant Tuberculosis
- Breastfeeding or Formula Feeding
- Stigma
- Conclusion
- Case Studies
- Key Messages
- Acknowledgments
SECTION IV: HIV AND THE ADOLESCENT
4.1:Growing Up with HIV: The Challenges and Concerns Associated with Perinatally Infected HIV-1 Positive Youth
- Causes of Death and Spectrum of Disease
- Reproductive Health and Perinatal HIV
- Treatment and Management of the Perinatally-infected HIV Youth
- Drug Resistance and Resistance Testing
- Choosing an Effective Antiretroviral Regimen
- Long-Term Complications
- Conclusion
4.2:Neurodevelopmental, Neurocognitive and Neuropsychological Outcomes in Adolescents with Perinatal HIV-1 Infection
- Introduction
- Neurodevelopmental Outcomes
- Neurobehavioral Outcomes
- Recent Developments
- Case Studies
  - Medical History
  - Follow-up of Patient
    - Questions
    - Answers
SECTION V: MANAGEMENT ISSUES OF HIV INFECTED CHILDREN
5.1:An A, B, C, D Approach to Nutrition in the HIV Infected Child
- Introduction
- Malnutrition and HIV Infection
- Nutrition in the HIV Infected Child
- Maternal Nutrition Status during Pregnancy
- Maternal HIV Infection and Anti Retroviral (ARV) Medication
- Infant Feeding and the Prevention of Mother-to-Child Transmission (PMTCT)
- Antiretroviral Therapy during Breastfeeding
- Nutrition Status of HIV Infected Children
- The A, B, C, D of a Nutrition Care Plan for HIV Infected Children
  - Overview
  - Anthropometry
  - Nutrition Assessment in Young Children
  - Normal Growth in Infants and Children
  - Growth Faltering (GF)
  - Interpretation of Growth Charts
  - Growth Velocity
  - Factors Leading to Growth Faltering
- Classifications of Malnutrition
  - Mid Upper Arm Circumference (MUAC)
  - Biochemical
  - Biochemical Assessment for Lipodystrophy
- Clinical
  - Classification of HIV/AIDS in Pediatrics
  - Clinical Assessment
- Dietary
  - Indian Food Pattern
- Interaction between HIV/AIDS and Nutrition
- Household Food Security
- Diet History
  - Commonly used Drugs in Management of HIV/AIDS
- Nutrition Management
- Coping with the Nutrition Complications of HIV/AIDS
- Monitoring and Documentation
- Nutrition Rehabilitation and Food Based Dietary Guidelines
  - Food Based Dietary Guidelines for Infants, Young Children and Adolescents
- Conclusion
  - Step 1: Assess, classify and decide on a nutrition care plan
  - Step 2: Assess the child's nutritional needs
  - Step 3: Decide a nutrition care plan
  - Nutrition Care Plan A for the Child who is Growing well ± ART
  - Nutrition Care Plan B for the Child with Poor Weight Gain or Increased Nutritional Needs
  - Nutrition Care Plan C for the Severely Malnourished HIV Infected Child
- Review
  - Step 4: What does the child eat and drink?
  - Step 5: Discuss who gives the child food and how the child eats ?
  - Step 6: Assess if there is food and income at home
  - Step 7: Discuss exercise and avoid risk factors for malnutrition
  - Step 8: Decide if to refer and when to review
5.2:Vaccinations for HIV Infected Children
- Introduction
- Epidemiology
- Recent Development in Vaccination of HIV Infected Infants
- Recommendations Regarding Vaccines and Schedules
- Specific Problems and Solutions
5.3:Management of HIV Infection During Infancy
- Clinical Manifestations
  - Does Primary HIV Infection Manifest in Young Children?
- Symptomatic Disease
- HIV-related Mortality
- Risk Factors for Disease Progression and Death during Infancy
- Confirming HIV Infection
- Prophylaxis and Treatment
  - Cotrimoxazole Prophylaxis
  - Isoniazid Prophylaxis
- ART for Asymptomatic Infants
- Severe Opportunistic Infection
- Benefits of Early Art
- Antiretroviral Considerations
  - Perinatal Nevirapine Exposure
  - Lopinavir/Ritonavir Dosing
- Tuberculosis Co-treatment
- Second Line Therapy after LPV/r
- Conclusion
- Case Studies
5.4:Prevention of Opportunistic Infections and Other Infectious Complications of HIV in Children
- Microbial Spectrum of OIs in Children
- General Considerations in OI Prophylaxis
- Serious or Recurrent Bacterial Infection
- Mycobacterium Tuberculosis
- Mycobacterium Avium Complex (MAC) Disease
- Pneumocystis Pneumonia (PCP)
- Candida Infections
- Cryptococcosis
- Aspergillosis
- Histoplasmosis
- Coccidioidomycosis
- Cytomegalovirus Disease
- Herpes Simplex Virus
- Varicella-Zoster Virus (VZV) Infections
- Hepatitis B Virus (HBV) Infections
- Hepatitis C Virus (HCV) Infections
- Toxoplasmosis
- Malaria
- Leishmaniasis
- Cryptosporidiosis, Microsporidiosis and Isosporiasis
5.5:Risks and Management of Occupational and Nonoccupational Exposure in Pediatric HIV
- Introduction
- Post Exposure Prophylaxis Following Occupational Exposure to HIV
- How PEP Works?
- Is Postexposure Prophylaxis Recommended for all Types of Occupational Exposures to HIV?
- Determination of the Exposure Code (EC)
- What Specific Drugs are Recommended for PEP?
- What About Exposure to Blood for which the HIV Status of the Source Person is Unknown?
- Testing and Counseling Following Exposure
- Availability of PEP
- Occupational Exposure Management Resources
- Considerations in Initiating Antiretroviral Therapy for PEP
- Postexposure Prophylaxis Following Non-Occupational Exposure to HIV
- Considerations for Vulnerable Populations
- Summary
5.6:Managing Failing ART Regimens in Children
- Epidemiology
- Current Treatment Recommendations and Implications for Future Options
- Treatment Failure in Children
- Management of Treatment Failure
  - Adherence
- Switching Therapy
- Holding Regimens
- Resistance Testing
- New Drugs in the Pipeline for Pediatric Use
- Salvage Therapy
- Case Study
5.7:Laboratory Monitoring of HIV in Children
- Introduction
- Immunologic Monitoring
- Quantitative Virologic Monitoring
- Monitoring HIV Drug-Resistance
- Therapeutic Drug Monitoring (TDM)
5.8:Antiretroviral Treatment Toxicities in Children
- Introduction
- Definition of Toxicity and Classification
- Mitochondrial Toxicity
- Lipodystrophy Syndrome (LDS)
- Dyslipidemias
- Insulin Resistance
- Disorders of Bone Metabolism
- Metabolic Considerations before Beginning ARV Therapy
- Risk Factors for Cardiovascular Disease (CVD)
- Case Studies
  - Hepatic Toxicity of ARVs
    - Toxicity Grading:51
  - Hematologic Effects of ARVs
5.9:Adherence to Antiretroviral Therapy in Children—Challenges and Strategies
- Introduction
- The Need for Adherence (Fig. 5.9.1)
  - Health Belief Model
  - Stages of Change Model
- Pre-ART Phase
- Other Supportive Strategies
- Measurement of Adherence
- Currently Available Measurement Tools
- The Need for a Multimethod Approach
- Challenges
- Assessment of Adherence
  - Family
    - Adolescents
- Interventions to Improve Adherence
- Role of Education, Information and Counseling Interventions (Table 5.9.4)
- Impact of Financial Incentives
- Impact of Technology Interventions
- The Way Ahead—A Biosocial Approach
SECTION VI: MISCELLANEOUS ISSUES
6.1:HIV-1 Drug Resistance
- Introduction
- Pathogenesis
- Clinical Implications of Antiretroviral Resistance
- Mechanisms of Antiretroviral Drug Resistance
- Conclusion
6.2:Psychosocial Issues in Children Infected/Affected with HIV
- Introduction
- Disclosure
  - Disclosure by Caregivers to Children
- Case Studies
- Adherence
- Cognitive Impairment in Youth with HIV
- Psychological Symptoms and Psychiatric Disorders in Youth with HIV
- Loss and Grief
- Transition
- Testing
- End-of-life Care
- Psychosocial Concerns in HIV Affected Populations
- Summary
6.3:Professional, Ethical and Legal Issues for the Indian HIV Infected Child
- Background
  - Who is a Child?
  - Who is a Child Affected by HIV/AIDS?
- Children's Rights
- Basic Ethical and Legal Issues
- Children in Families
- Children in Schools
- Children and Health Care
- Children and the Right to Education and Information
- Children and Social Security
- Children at Work
- Children on the Streets
- What the Law Says
- Landmark and Relevant Judgments
- Retention of Health Records
  - With Respect to Children
    - Point No.2
- Key Messages
6.4:Nursing Issues in Children with HIV
- Introduction
  - Occupational Risks, Attitude, Stigma and Discrimination
- Occupational Exposure Risk of HIV
- Universal Precautions with Blood and Body Fluids
- Hospital Admissions
  - When a child Needs to be Nursed in Isolation
- Malnutrition
- Health Professional Attitudes to HIV positive Children and their Families
- Conclusion
6.5:Care of an HIV Positive Child in Day-to-Day Life
- Introduction
- Support and Understanding
- Living Together with HIV
- Prevention of HIV Transmission and Hygiene Rules in Daily Life
- Examples of Good Practice on Infection Control in Educational Settings8
- Self-Esteem and Identity
- Confidentiality
- Conclusion
6.6:Orphans of the AIDS Epidemic
- Introduction
- Global Trends
  - India
- Definition
- Impact of Illness
  - Exploitation, Family and Social Security, Stigma and Discrimination
- OVC Care Model
6.7:Interventions of the NGOs Caring for HIV Infected/Affected Children in India
- Introduction
- Definition of Orphan and Vulnerable Children in India
- Issues Related to Orphan and Vulnerable Children
- NGO Interventions
List of NGOs Working for Orphans and Vulnerable Children in India
- Andhra Pradesh
- Andaman and Nicobar Islands
- Assam
- Bihar
- Chandigarh
- Goa
- Gujarat
- Haryana
- Himachal Pradesh
- Jammu and Kashmir
- Karnataka
- Kerala
- Madhya Pradesh
- Maharashtra
- Manipur
- Mizoram
- New Delhi
- Orissa
- Puducherry
- Punjab
- Rajasthan
- Sikkim
- Tamil Nadu
- Tripura
- Uttar Pradesh
- West Bengal

INDEX

ABCDEFGHIJKLMNOPQRSTUVWXZ

Page numbers followed by f refers to figures and t refers to tables

Abdominal sonar 237

Aberrant immune activation 9

Abnormal

fluid balance 172

liver function tests 315

Absolute CD4 cell count 43

Acid-base balance 172

Acid-fast bacilli 162, 240

Acquired immune deficiency syndrome 196, 239, 417

Actinomycetem comitans 113

Active CMV retinitis 99

Acute

and chronic HCV infection 267

HBV infection 255

hepatitis B virus infection 256f

interstitial nephritis 81

pyogenic pneumonia 241

renal failure 81

retina necrosis 101

retroviral syndrome 209

tubular

dysfunction 170, 172

necrosis 81

Adolescents 544

Advantages of

breastfeeding 358

formula feeding 358

Adverse drug reactions mimicking TB-IRIS 285

Aerosolized pentamidine 469, 470

Alanine aminotransferase 279

Algid malaria 277

Alterations in gastrointestinal function 205

Alveolar hemorrhage 144

American

Academy of Pediatrics classification 521

Dental Association 126

Amprenavir 183, 560

Anemia 163, 528

of chronic disease 164

Angular cheilitis 109, 112, 112f, 300

Annular scaly plaques 91f

Anthropometry 420, 421

Antibiotic chemoprophylaxis 471

Anti-HBs levels 448

Antiretroviral

drugs in emergency department 301

perinatal transmission prophylaxis 359

resistance 555

therapy 72, 269, 366

during breastfeeding 420

in pregnancy 332

treatment toxicities in children 518

in pregnant women 319

Antituberculous

therapy 102

treatment 241

Aphthous

stomatitis 109

ulcers 82, 115f

Artemether 276

Arteriopathy 158

Artesunate 276

Arthralgias 449

ARV

in HIV exposed infected infants 13

therapy 523

Aspartate aminotransferase 184

Aspergillosis 475

Aspergillus fumigatus 81

Asplenia 449

Asthma 144

Atazanavir 183, 321

Atopic dermatitis 82

Atovaquone 469, 470

Atypical

mycobacteria 144

syphilis 87

mycobacterial infection 87

Autonomic dysfunction 158

Azithromycin 469, 470

Bacillary angiomatosis 82, 87

Bacillus Calmette Guèrin 248, 283

Bacterial

infections of oral tissues 109, 116

keratitis 103, 106

meningitis 138

pneumonias 150

Baseline HIV 43

BCG

iris 231, 288f

syndromes 231

Bilateral

fibrocavitatory TB 76f

parotid gland enlargement 114f

Blackwater fever 276

Blastocystis hominis 188

Bleeding in pregnancy 315

Blepharitis 99

Blood

chemistry 159

results 235

test normal range 425

transfusions 255

Bone

disease 398

marrow

aspiration test 237

in HIV infection 162

mineral density 398

Breastfeeding 380

issues in context of HIV 367

Bronchiectasis 144, 154

Bronchoalveolar fluid 150

Burkitt's lymphoma 212, 213

Calcifications of basal ganglia 77f

Candida 471

albicans 15, 74, 79, 81, 110, 113, 223, 300

infections 300, 473

tropicalis 300

Candidiasis 87, 90, 110, 223

in pregnancy 311

of trachea 74

Cardiac

catheterization 159

manifestations in HIV infected children 156

tumors 158

Cardiorespiratory emergencies in HIV infected child 297

Cardiovascular

disease 524

system 80

Causes of

acute renal failure in children with HIV 172

death and spectrum of disease 390

renal failure 172

Central

nervous system 77, 131

toxoplasmosis 74

obesity 519

Cerebral

atrophy 77f

and dilated ventricles 405f

malaria 276

Cerebrospinal fluid 134

Cervical

cancer 216

dysplasia in pregnancy 311

lymphadenopathy 109, 121

Chickenpox 87

Childhood immunizations in HIV infected children 14

Children's rights 587

Cholangitis 234

Cholecystitis 234

Chorioamnionitis 316

Choroid 98

Choroiditis 102

Chronic

anterior uveitis 99

cryptosporidiosis 74

HBV infection 256, 257t, 257f

herpes simplex infection 74

HIV infection in children 17t

isosporiasis 74

multifocal retinal infiltrates 99

painful ulcers involving flexures 87f

renal failure 81

respiratory diseases 154

Ciprofloxacin 232

Clarithromycin 469, 470

Classes of antiretroviral drugs 48t

Classification of

growth disorders in HIV infected subjects 199

HIV/AIDS in pediatrics 424

immune suppression in children 511

malnutrition 423

oral lesions 108

orofacial lesions 109

Clindamycin 469, 470

Clinical

classification of HIV infected children 71

diagnosis of HIV in infants 23

Clostridium difficile 187–189

CMV

antigenemia 227

colitis 226

DNA PCR 227

gastrointestinal disease 226

hepatitis 226

neurological disease 227

pneumonitis 227

retinal detachment 106f

retinitis 226

Cobblestone appearance 474

Coccidioides immitis 144

Coccidioidomycosis 476

Coccidiomycosis 470

Cognitive disorders 400

Colonies of candida albicans on labial mucosa 111f

Common

causes of renal failure in HIV 81

cutaneous manifestations of HIV/ AIDS 87t

Computer assisted self-interviewing 542

Confirming HIV infection 453

Congestive heart failure 156

Conjunctiva 99, 107

Consequences of aberrant T cell activation 9

Contraception advice 318

Control of cross infection 126

Coomb's test 164, 166

Coronary artery disease 157

Correlation of dermatoses with CD4 count 87

Cotrimoxazole prophylaxis 365, 454

Cotton-wool spots 99

Crusted scabies 87

Cryptococcal

choroiditis 106

disease 223

Cryptococcosis 87, 470, 474

Cryptococcus

albidus 102

neoformans 79, 81, 135, 144, 162, 192, 312

pneumonia 249

Cryptosporidiosis 484

Cryptosporidium

diarrhea 206

hominis 206

infection 301

parvum 206, 301

CSF abnormalities 242

Cutaneous and conjunctival lymphoma 105

Cyclospora cayetanensis 188

Cystic fibrosis 144

Cytomegalovirus 7, 87, 109, 137, 144, 152, 163, 226

associated ulcer on buccal mucosa 118f

disease 476

infection 74, 300, 311

retinitis 99

Cytotoxic T cells 6

Darunavir 183

resistance 562

mutations 563

Delavirdine 183

Demyelinating disease 134f

Dental caries 108, 122, 122f

Dermatological

iris 285

manifestations of HIV in children 86

Dermatophyte infection 87

Detection of

cell-associated virus-encoded DNA 29

viral

antigen in plasma 28

RNA in plasma 28

Determination of exposure code 490

Determine exposure code 491

Determining HIV status in HIV exposed children 364

Development of

drug resistant viruses 534f

resistance to antiretroviral therapy during PMTCT 348

Diagnosis of

HIV infection in infants and children 12

smear positive pulmonary TB 244f

TB in newborn 377

Diarrhea 187

Diarrheal

diseases 206

illnesses 207

Didinosine 319

Dilated cardiomyopathy and myocarditis 156

Directly observed treatment short course 147

Disadvantages of

breastfeeding 358

formula feeding 358

Disorders of bone metabolism 522

Disseminated

BCG disease 283, 448

disease 231

endemic mycosis 74

nontuberculous mycobacterial infection 74

Distant disease 231

Dried blood spots 28

Drug

induced uveitis 106

interactions 50–52, 500

modifications in renal failure 174

resistance

and resistance testing 396

interpretation 505, 507

resistant TB in children 248

toxicities 172

used

for treatment of tuberculosis 244t

in HIV 174

Dry eye 99

Dual disease 231

Dyslipidemias 520

Earlier initiation of ART in infants 287

Eczema 87

Educational continuum 547

Efavirenz 183, 320

Effect of

HBV infection on HIV disease progression 258

HCV infection on HIV disease progression 268

HIV infection on

HBV disease progression 258

HCV disease progression 268

pregnancy 309

HIV on

CD4 and HIV RNA levels in pregnancy 309

course and outcome of pregnancy 309

Electrolyte fluid abnormalities 172

Emtricitabine 183, 319

Encephalitis 470

Encephalitozoon intestinalis 188

Endocarditis 158

Endoscopic retrograde cholangiopancreatography 189f

Enlargement of lymph nodes in right hilum 147f

Enterocytozoon bieneusi 188, 486

Enzyme-linked immunosorbent assay 209

Epidemiology of HIV in pregnancy 307

Epidermodysplasia verruciformis 96

Epstein-Barr virus 115, 144, 213, 216

Erythema 92f

induratum 91

Erythematous

candidiasis 112, 1112f

nodules of Kaposi's sarcoma obstructing vision 94f

plaques in groin healing with hypopigmentation 93f

Escherichia coli 82, 294

Esophageal candidiasis 74, 223

Ethambutol 232, 470

Etravirine 183, 320, 563

Euthyroid sick syndrome 206

Exclusive

breastfeeding 357

formula feed 358

Extensive

bilateral miliary mottling 148f

geographic hemorrhagic macules on limbs 94f

molluscum contagiosum 73

plane warts on trunk 89f

wart virus infection 73

Extrapulmonary

cryptococcosis 74

TB caseating lymphadenopathy 76f

TB in children 242t

Eyelids 99

Factors

affecting transmission 331

leading to growth faltering 422

Features of PML 78f

Fetal malformations 315

Fever in HIV infected child 293

First line anti-TB drugs 149

Fixed

dose antiretroviral formulations for children 62t

drug combinations 53

Flash

heating of expressed breast milk 368, 373

heating technique 358

Fluconazole 470, 471

Follicle-stimulating hormone 198

Folliculitis 91f

Foreign body aspiration 144

Formula feeding 380

Fosamprenavir 183

resistance 560

Frosted branch angiitis 100f

Fungal

infections 102, 220

nail infections 73

Ganciclovir 470

Garbage disposal 603

Gastrointestinal

and hepatobiliary

manifestations in children with HIV 181

system 79

emergencies in HIV infected child 294

toxicities 527

Genital

herpes simplex viral infection in pregnancy 310

screen in pregnancy 310

Genotypic resistance testing 319

Gestational diabetes 315

Giardia lamblia 206, 294

Global BCG coverage 230f

Goals of antiretroviral therapy in children 47

Gonadotropin-releasing hormone 198

Groin in condyloma accuminata 89f

Gross inguinal lymphadenopathy typical of childhood Kaposi's sarcoma 94f

Growth

hormone releasing hormone 198

monitoring 363

velocity 422

Guillain- Barré syndrome 449

Haemophilus influenzae 16, 74, 144, 150, 158, 294

Hairy leukoplakia 108

HBV infection 255t

HCP exposure 488

Headache 449

Helicobactor pylori 213

Hemoglobinuria 275

Hemolytic uremic syndrome 81, 165

Hepatic

necrosis 183

steatosis 183

toxicity of ARVS 527

Hepatitis 190, 234

A 449

B 224

in HIV infected pregnant women 313

virus 190, 253

C 225

and HIV coinfection 225

in HIV infected pregnant women 313

virus 265

Hepatobiliary disease 190

Hepatocellular carcinoma 255, 265

Herpes

simplex 82, 87

ulcers 87

virus 72, 112, 115, 144, 209, 227, 478

virus infection 87f

zoster 72, 73, 87, 109, 119, 119f

ophthalmicus 103, 103f, 106

Herpetic stomatitis 109

Herpetiform recurrent aphthous ulcers 116

Highly active antiretroviral therapy 21, 78, 170, 223, 307, 389

Hilar lymph gland enlargement 146f

Histoplasma capsulatum 81, 144, 162

Histoplasmosis 471, 475

HIV

and HBV co-infection 254

and HCV co-infection 266

and hepatitis C co-infected children 266

and immune system 5

and tuberculosis co-infection in children 239

associated

cardiovascular abnormality 81t

immune complex kidney disease 170

nephropathy 81, 170

disease progression 4, 10

encephalopathy 74, 133

infected

blood 489

children 3

myelopathy 141, 141f

myopathy 141

polyneuropathy 140

positive child with spastic encephalopathy 77f

post-exposure prophylaxis guidelines 599

mortality 453

neuropathy/myopathy/ myelopathy 140

retinopathy 99

testing 587

kits 308

transmission rates with ZDVM 343f

viral load 339

Hodgkin's

disease 216

lymphoma 87

HSV bronchitis 72

Human

biting 604

herpes virus 120, 214

immunodeficiency virus 41, 43t, 123, 181, 196, 417, 598

papilloma virus 118, 216, 311

Hypercholesterolemia 520, 521t, 525

Hyperinflation of right middle and lower lobe 147f

Hyperkeratotic papules 90

Hyperparasitemia 275

Hyperplastic white plaques 300

Hypersensitivity 448, 449

syndrome 183

Hyperthermia 275

Hypertriglyceridemia 521t

Hypogammaglobulinemia 469

Hypoglycemia 276

Iatrogenic uveitis 99

Idiopathic thrombocytopenia purpura 528

IgA nephropathy 81

Immune

reconstitution

in HIV infected children 14

inflammatory syndrome 94, 144, 182, 231, 278, 312

recovery uveitis 105, 107

Immunization in pregnancy 314

Impaired brain growth 134

Importance of orofacial lesions in HIV infection 123

Indinavir 183, 321

resistance 560

Indirect hyperbilirubinemia 527

Infant mortality 316

Infections of central nervous system 135

Infectious complications of HIV in children 464

Influenza 448

viruses 152

Insulin

like growth factor binding protein 197

resistance 521

Integrase inhibitors 52, 502, 563

International AIDS Society 368

Interpretation of

growth charts 422

hepatitis B serologic test results 256t

Intra-abdominal adipose tissue 204

Intraocular inflammation 99

Intrauterine growth retardation 316

IRIS uveitis 470

Isoniazid prophylaxis 454

Isospora belli 188

Isosporiasis 484

Itchy erythematous papular eruption of extensors 93f

Itraconazole 470, 471

Jaundice 275

JC virus 78, 138

Kaposi's sarcoma 72, 74, 82, 87, 99, 107, 108, 109, 120, 212, 249

of eyelid and conjunctiva 105

Keratoconjunctivitis sicca 105, 107

Kinyoun stain 301

Klebsiella pneumoniae 144, 381

Laboratory monitoring of HIV in children 510

Lactate dehydrogenase 175

Lactic

acidosis 315

dehydrogenase 151

Lamivudine 183, 262, 320

Large

cell lymphomas 213

vessel disease 104

Leiomyosarcomas 72, 216

Leishmaniasis 483

Leucovorin 469, 470

Levofloxacin 232

Lichen scrofulosorum 91

Life cycle of HIV 47

Linear gingival erythema 73, 108, 109, 113, 114

Lipoatrophy 525

Lipodystrophy 424, 525

syndrome 519

Live attenuated vaccines 360

Liver biopsy 237

Local BCG disease 230

Long-term chemoprophylaxis 277

Lopinavir 183, 320, 458

Low birth weight 316

Lupus-like glomerulonephritis 81

Luteinizing hormone 198

Lymphadenopathic KS 214f, 215f

Lymphadenopathy 449

Lymphoblastic lymphomas 213

Lymphoid interstitial pneumonitis 42, 74, 115, 152, 241

Lymphoma 72, 99, 144, 249

Lymphoproliferative thymic cysts 144

Magnetic resonance imaging 78

Major

aphthous ulceration 116f

histocompatibility complex 7

recurrent aphthous ulcers 116

toxicities of antiretrovirals 65t

Malaria 233, 483

and HIV infection 273

in pregnancy 315

Malnutrition and HIV infection 417

Management of

asymptomatic newborn 377

concomitant HIV and hepatitis C 268

delivery 317

hepatitis B and HIV 258

HIV infection during infancy 451

hypercholestrolemia and hypertriglyceridemia 521

LDS 520

neonate 318

pregnant woman with TB and HIV 378

symptomatic newborn 377

TB exposed newborn 377

treatment failure 499

Mantoux test 208

Marasmus 234

Maternal

HIV infection and

antiretroviral medication 418

intrauterine growth 200

mortality 378

nutrition status during pregnancy 418

Maxillary anterior gingiva 111f

Measles 448

Mechanisms of antiretroviral drug resistance 555

Medical complications in HIV positive pregnant women 314

Medication event monitoring system 540, 541

Membranoproliferative glomerulonephritis 81

Membranous glomerulonephritis 81

Meningococcal

conjugate 449

polysaccharide vaccine 449

Metabolic acidosis 275

Methamine silver 177f

Methods of detection of PCP 220t

Microbial spectrum of OIS in children 464

Microcytic hypochromic 164

Microsporidiosis 471, 484

Mid upper arm circumference 423

Miliary TB from lip in children 241t

Minor

aphthous ulceration 116f

recurrent aphthous ulcers 116

Mitochondrial toxicity 518

MMR 449

Modified kinyoun acid-fast staining 189f

Molluscum contagiosum 82, 87, 88, 88f, 104, 106, 109, 119f, 119

Monitoring HIV drug-resistance 515

Moraxella catarrhalis 74

Morbilliform truncal eruption 93f

Mother-to-child transmission 307

Moxifloxacin 232

Mucosa associated lymphoid tissue lesions 144

Multidrug resistant

tuberculosis 379

virus 216

Mutation scoring 505, 507

Mycobacteria 139

Mycobacterial

disease 102, 106

infections 229

Mycobacterium

abscessus 229

africanum 229

avium

complex 163, 182, 229, 312, 464

complex disease 298, 468

intracellulare 80, 206, 278

bovis 229, 248

kansasii 229

marinum 229

scrofulaceum 229

tuberculosis 72, 80, 102, 139, 153, 189, 229, 239, 298, 312, , 466

and avium 157

associated iris 284

complex 229

ulcerans 229

Myelopoiesis 165

National

AIDS control

Organization 310

Program 149

Vector Borne Disease Control Program 273

Nausea and vomiting 314

NCEP classifications 520

Necrotizing

herpetic retinopathy 101, 106

stomatitis 109, 117, 118f

ulcerative

gingivitis 109, 116, 117f

periodontitis 109, 113, 117, 117f

Negative blood culture 471

Neisseria meningitidis 303

Nelfinavir 183, 320

resistance 560

Neurologic

disease 470

emergencies in HIV infected child 297

manifestations of HIV 208

Neurological

IRIS 286

manifestations of HIV in children 131

Neuro-ophthalmic disorders 99

Neutropenia 165, 528

Nevirapine 183, 320, 529

NNRTI-based regimens 523

Nocardiosis 72

Non-Hodgkin's lymphoma 81, 87, 105, 109, 120, 212

Non-nucleoside reverse transcriptase inhibitor 47, 183, 246, 500

Non-ocular infection 471

Nonspecific

electrolyte abnormalities 172

therapy 222

Nontuberculous

mycobacterial IRIS 285

Mycobacterium 229

Normal growth in infants and children 421

Normocytic normochromic 164

Nucleic acid sequence-based amplification 23

Nucleoside

analogues 172

reverse transcriptase inhibitors 183

Nutrition

in HIV infected child 418

status of HIV infected children 420

Obstetric complications in HIV positive pregnant women 315

Ocular

manifestations of pediatric HIV infection 98

surface and adnexa 98

syphilis 106

tuberculosis 102f

Oligohydramnios 316

Oocysts of cryptosporidium 189f

Opportunistic infections 98, 144

Oral

hairy

leukoplakia 82, 87, 109, 120, 121f

leukoplakia on lateral border of tongue 186f

lesions for disease classification 125

manifestation of HIV infection 109

ulceration 115

Orofacial manifestations associated with HIV infection 110

Palatal lesion 215f

Pancreatitis 192, 234

Pap tests 203

Papilloma virus vaccine 449

Papular

eruptions 87

eruptions of HIV 93

pruritic eruptions 73

urticaria 91

Papulonecrotic tuberculid 91

Para influenza viruses 152

Parasitic infections 233

Paratracheal lymphadenopathy 287f

Parotid

enlargement 109

gland enlargement 108

Pathogenesis of

cytopenias 162

HIV progression 42f

impaired growth 203

impaired sexual maturation 206

perinatal TB 376

PCP prophylaxis 222t, 223t

PCR test 364

Pediatric

HIV 43t

classification 73t

disease 161

infection 47, 124t, 212

spectrum of disease 391

Penicillium marneffei 144

Pericardial disease 157

Perinatal

HIV and tuberculosis infection and management 375

mortality 316

nevirapine exposure 457

retrovirus infection care plan 322- 324, 326

Periodontal diseases 82, 108, 109, 116

Peripheral

lipoatrophy 519

nervous system 131

Persistent

fever 72

ulcer 448

Petechiae 109, 122

Pets and bloodsucking insects 603

Physiology of puberty and adolescence 198

Pill count 541

Pills identification test 542

Plasmodium falciparum 273

Pneumocystis 102, 106, 220

carinii 75

pneumonia 241, 361

jiroveci 41, 80, 144, 190, 220, 250, 300, 456, 471

infection 220

pneumonia 72, 151, 249, 250, 293, 311

pneumonia 74, 471

Pneumonia and bacterial infections 285

Point of care tests 308

Polio vaccine 449

Polyfunctional T cells 16

Polymerase chain reaction 104, 151, 208, 234

Polymorphonuclear leukocytes 209

Polypoid skin lesions 215f

Postexposure prophylaxis 309

Postinflammatory hypopigmentation of central face in seborrheic eczema 92f

Postpartum breastfeeding HIV transmission 368

Preterm prelabor rupture of membranes in HIV positive women 316

Pretreatment active CMV retinitis 100

Prevalence of

chronic

HBV infection 254f

HCV infection 266f

hepatitis B in HIV exposed 261

HIV transmission and hygiene rules in daily life 603

in utero and intrapartum HIV 338

IRIS 286

opportunistic infections 464

Primary

CNS lymphoma 140, 213

complex of TB 76f

Progression to cirrhosis and

hepatocellular carcinoma 258, 268

Progressive

bilateral pyramidal tract signs 134

multifocal leukoencephalopathy 74, 78

outer retinal necrosis 101

Prominent cervical lymphadenopathy 92f

Protease inhibitors 47

Protein calorie malnutrition 182

Pruritus 87

Pseudomembranous

candidiasis 110t, 111, 111f

gingivitis of tongue 111f

Pseudomonas aeruginosa 74, 103, 144, 465

Psoriasis 82

Psychosocial concerns in HIV affected populations 582

Puberty 198

in HIV infected children 201

Pulmonary

hypertension 158

Kaposi sarcoma 144

malignancies 154

manifestations in children with HIV 144

tuberculosis 145, 249

Pure red cell aplasia 163

Pyoderma 90

Pyrimethamine 469, 470

Quinine 276

Quinolone 232

Rationale for HIV staging and prognosis 510

Recurrent

abdominal symptoms 236

aphthous ulcers 109, 115

bacterial infection 465

oral ulcerations 73

severe bacterial infections 74

Renal

disease 398

in pediatric HIV infection 170

failure 275, 276

replacement therapy and transplantation 177

tubular function 172

Reproductive health and perinatal HIV 391

Resistance test 504, 506

Respiratory

illnesses 207

syncytial virus 152

system 74

Retina 98

Retinal detachment 106, 107

Retinitis 470

Revised

National Tuberculosis Control Program 147

pediatric classification 230

Rifabutin 232, 469, 470

Rifampacin 377

Ritonavir 183, 458

RNTCP treatment regimens 149

Role of

adjuvant steroid treatment 247

endocrine dysfunctions 203

Rotavirus 448

Salivary gland disease 114

Salvage therapy 503

Saquinavir 183, 320

resistance 560

Sarcoid 144

Scabies 82, 87, 89

Screening for genital infections 203

Seborrheic

dermatitis 82, 109, 117

eczema 87, 92

Second-line anti-TB drugs for treatment of MDR-TB in children 248t

Segmental

atelectasis of right upper lobe 147f

sclerotic lesions in focal segmental glomerulosclerosis 177f

Serologic

and virologic testing methods 29t

Serologic screening tests 29

supplemental tests 29

Severe

bilateral bronchopneumonia 147f

gastroesophageal reflux 144

HIV disease 74

malabsorption 234

malaria 275

opportunistic infection 455

pneumonia 74

sepsis 74

Sexual

abuse in pregnancy 309

assault survivors 495

health screening for genital infections 319

Sexually transmitted

diseases 446

infections 310, 391

Short-term chemoprophylaxis 277

Skin

biopsy 237

emergencies in HIV infected child 295

nodules 215f

rash with ARVS 529

Slim disease 83

Small noncleaved cell lymphomas 213

Specialized laboratory evaluation of HIV infected children 15

Spirochetal infections 103

Splenic rupture 277

Spontaneous

abortion 315

pneumothorax 144

Squamous cell carcinoma 99, 106

of conjunctiva 104

Standardized incidence rate 213, 216

Staphylococcal infection candidiasis 82

Staphylococcus

aureus 81, 103, 144, 150

epidermidis 103

Stavudine 183

Stevens-Johnson syndrome 106, 529

Streptococcus pneumoniae 42, 74, 116, 144, 150, 178, 381

Stress testing 159

Strongyloides stercoralis 144

Subarachnoid hemorrhage 142

Subcortical and basal ganglia calcifications 405f

Subcutaneous adipose tissue 204

Sulfadiazine 470

Sulfamethoxazole 365

Superficial fungal infection 90

Switching therapy 500

Symptomatic disease 452

Syphilis 138

in HIV infected pregnant women 310

Systemic

fungal infections 87, 92

hypersensitivity reaction 529

T cell

and HIV infection 6

receptor 14

excision circles 14

Talbot classification 230

Target sites of drugs for HIV 48

Tenofovir 183, 319

Therapeutic drug monitoring 319, 516, 540

Thrombocytopenia 164, 276

Thrombotic thrombocytopenic purpura 165, 175

Thymic function in HIV infected children 5

Thymidine analogue mutations 501

Tinea

capitis 87

infection 91f

Tipranavir 183

Total lymphocyte count 512, 513f

Toxoplasma 469, 470

gondii 79, 136, 144, 192, 233, 313, 481

Toxoplasmosis 72, 101, 301, 481

Transcriptase inhibitors 48

Treatment for CMV retinitis 101t

Treatment of

disease 233

P. falciparum 275

P. vivax 275

tuberculosis and monitoring in HIV-TB children 244

uncomplicated malaria 275

Treponema pallidum 103

Trimethoprim 365

Triple-NRTI regimen 524

Truncal

hyperkeratotic plaques accentuated in axillae 90f

itchy papules 91f

Tubercular granulomas 139f

Tuberculin

skin test 146

test 208

Tuberculoma in posterior cranial fossa 78f

Tuberculosis 91, 208

in pregnancy 376

related ulcers 109, 121

Tuberculous

empyema 147f

meningitis 242t

Tumor

cells 216

necrosis factor 9

smooth muscle origin 144

Tzanck smears 104

Ulcerated plaque of lupus vulgaris 92f

Umbilicated papule of molluscum contagiosum recurring on HAART 95f

Unexplained persistent parotid enlargement 73

Unsafe

injection practices 255

sexual contact 255

Upper

GI disease 186

respiratory tract illnesses 144

Urinary tract infection 82, 176

Use of

antiretroviral

drugs in pregnancy 314

NPEP 495

infant ARV prophylaxis during breastfeeding 369

maternal HAART during breastfeeding 368

Vaccinations for HIV infected children 445

Vaccine associated paralytic poliomyelitis 448

Valganciclovir 470

Varicella 119, 448

Varicella pneumonitis 152

zoster 88, 228

infection 87

virus 101, 103, 109, 137, 144

Vasoactive intestinal peptides 203

Verruca plana 96

Verrucous

cauliflower nodules 89f

papule 89f

papule of verruca vulgaris 95f

Vertical transmission of

HIV 331

TB 376

Vesicles of varicella zoster 88f

Viral

and fungal pneumonias 152

culture 227

hepatitis 80, 224

infections 108, 109, 118, 224

Virus coinfections 183

Visceral adipose tissue 204

Visual analog scale 540, 542

Warts 87

on dorsum of fingers 89f

Wasting syndrome 72

Weighted classification of

darunavir mutations 562

etravirine resistance mutations 558t

tipranavir mutations 563t

Weighted mutation score 558, 563

Whitish cheesy plaques of candida on dorsa of tongue 90f

WHO classifications of moderate and severe malnutrition 423

Women-infant transmission study 339

Xerosis 87

Xerostomia 109, 119, 119f

Zidovudine 50, 94, 163, 317, 319

Ziehl-Neelsen stain 301

Zinc deficiency 87

TOC
Index

Chapter Notes