2. Introduction.
• 40 million people are estimated to be living
with HIV/AIDS.
• 3 millions are children.
• Epidemiology in recent times are the highest
between individuals 15-24 years of age.
• 95% of the people that have HIV live in the
developing world.
3. Mother to infant transmission.
• 35% of infants born to HIV+ will contract HIV
without interventions.
– 15-20% occur during pregnancy.
– 50% occur during labor/ delivery.
– 33% occur during breastfeeding.
4. Breastfeeding.
• Infants can contract HIV through
breastfeeding.
• In developing countries, formula is not often
available or is not financially possible, as a
result it would be an inevitable option.
• If the formula is available, then concerns are
directed at the cleanliness of the water supply
or sterilization of bottles.
5. Diagnosis.
• An infant < 18 months of age is considered
HIV-infected if they are sero+ or were born to
an HIV infected mother and has +results on
two separate HIV tests.
• An infant can be excluded by the
disappearance of anti-HIV antibody by 18
months of age – seroreversion.
6. Conditions associated with HIV.
• Malnutrition.
– Impaired nutritional absorption.
– Increased nutritional requirements.
– Reduced food intake.
– Lactose intolerance.
– Dehydration.
– HIV-induced diarrhea.
• Failure to thrive.
– Alterations in function of GI tract.
– Increased use of body fat stores.
– Oral lesions and HIV-specific gingivitis.
• Developmental delays.
• Micronutrient deficiencies.
– Depletion of vitamin and mineral stores.
• Neurological problems.
– Abnormal swallowing mechanisms.
– Impaired brain growth.
– Seizures/ Strokes.
• Opportunistic infections.
– Cryptosporidiosis.
– Tuberculosis.
• Normal infections are potentially fatal.
7. Other problems.
• Categorized as an ‘AIDS’ family – stigma.
• Psychological burden.
• Socioeconomic status.
• Access to medication.
8. Nutritional assessment.
• Detailed diet history.
• Medication history.
• Anthropometric data.
• Evaluation of weight changes.
• Laboratory data.
9. Management.
• Small frequent feedings.
• Nutrient supplementation.
• Soft-textured, moist foods at room
temperature.
• Fluids tolerated via a straw.
10. Management.
• Estimate energy needs using a Metabolic Cart,
RDA tables or Bentler & Stannish formula.
– 200kcal/kg & 4g/kg.
• Aggressive treatment of opportunistic infections.
• Tolerable anti-HIV regimen including a
combination of 3 different medications.
– 2 reverse transcriptase inhibitors (zidovudine +
tenofovir) + 1 protease inhibitor (indinavir) – weight
gain, improved mental functioning.
11. Management.
• Consult with doctor before immunizations/
booster shots.
• Evaluate feeding skills to see if tube feeding is
necessary or TPN is required.
• Diarrhoea.
– Lactaid milk & yogurt.
– Soy milk.
– Soluble forms of fibre – oatmeal, rice.
– Replace fluid loss with electrolyte solutions such as
Pedialyte.
12. Prognosis.
• Although HIV is usually deadly in children. The
development of anti-retroviral is promising.
• The nutritional status of the child and the diligence in
which viral replication is controlled is also important.
• Aggressive treatment of opportunistic infections are
important.
• Control of hematologic disturbances such as anaemia,
thrombocytopenia and neutropenia are also important.
• Natural progression of vertically acquired HIV infection
appears to have a trimodal distribution.
– 15% have rapidly progressive disease. The remainder has either
a chronic progressive course or an infection pattern.
– Mean survival is 10 years.
13. Prognostic factors.
• Advanced maternal disease.
• High maternal viral load.
• Low maternal CD4+ count.
• Prematurity.
• In utero transmission.
• High viral load in the first 2 months of life.
• Lack of neutralizing antibodies.
• Presence of p24 antigen.
• AIDS-defining illnesses.
• Early cytomegalovirus (CMV) infection.
• Early neurologic disease.
• Failure to thrive.
• Early-onset diarrhoea.
