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5 - Routine pediatric care
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- By Elaine Abrams, Department of Pediatrics, Harlem Hospital Center and College of Physicians and Surgeons, Columbia University, New York, NY, Rachel Y. Moon, Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, Lisa-Gaye Robinson, Department of Pediatrics, Harlem Hospital Center and College of Physicians and Swgeons, Columbia University, New York, NY, Russell B. Van Dyke, Department of Pediatrics, Tulane University Health Sciences Center, New Orleans, LA
- Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
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- Book:
- Handbook of Pediatric HIV Care
- Published online:
- 23 December 2009
- Print publication:
- 04 May 2006, pp 134-176
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Summary
Introduction
HIV infection is a chronic illness with diverse clinical manifestations and psychosocial challenges. The routine care of HIV-infected children demands a dedicated multidisciplinary approach from a variety of health care professionals including medical sub-specialists, nurses, psychiatrists, psychologists, dentists, social workers and case managers. The HIV primary care provider, while ensuring health maintenance and preventing disease, must serve as the coordinator of an array of services crucial to the management of these children in the context of the family. Important management considerations attend the care of both HIV-exposed children and those children ultimately identified as HIV-infected.
Care of the HIV-exposed infant
Routine care for the infant born to an HIV-infected mother should begin well before the infant's birth. Clinicians should collaborate with the mother's primary care providers to minimize the risk of HIV transmission. Care of the infant after birth includes continued interventions to reduce the risk of HIV infection, as well as HIV diagnostic evaluations and routine infant care (Table 5.1). Care of the HIV-exposed newborn in the hospital begins with a thorough maternal history, including HIV disease status [HIV RNA concentration (viral load), CD4+ lymphocyte count, and HIV-related complications), receipt of interventions to prevent mother-to-child transmission (e.g., antiretroviral prophylaxis, cesarean delivery before labor and before ruptured membranes), and history of other infections (e.g., syphilis, herpes simplex virus, hepatitis B and C, cytomegalovirus, toxoplasmosis, gonorrhea, or tuberculosis (TB)).
11 - Prevention of opportunistic infections and other infectious complications of HIV in children
- from Part II - General issues in the care of pediatric HIV patients
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- By Russell B. Van Dyke, Department of Pediatrics, Tulane University Health Sciences Center, New Orleans, LA
- Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
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- Book:
- Textbook of Pediatric HIV Care
- Published online:
- 03 February 2010
- Print publication:
- 28 April 2005, pp 153-167
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Summary
Introduction
AIDS was first recognized in 1981 when an unusual clustering of cases of Pneumocystis carinii pneumonia (PCP) occurred among young homosexual men in Southern California, USA. Subsequently, other opportunistic infections were identified in this population, including disseminated mycobacterial infections, toxoplasmosis, and cytomegalovirus retinitis. Soon thereafter, these same opportunistic infections were identified in children. The occurrence of this group of distinctive opportunistic infections remains central to the definition of AIDS. The recognition that HIV-infected individuals are at increased risk for certain specific opportunistic pathogens has stimulated the development of strategies to prevent these infections.
For most HIV-associated opportunistic infections, the risk of infection is correlated with the patient's degree of immunosuppression. Thus, guidelines for initiating prophylaxis are generally based upon the number of circulating CD4+ lymphocytes in the peripheral blood. The normal CD4+ lymphocyte count is substantially higher in infants than in older children and adults, with normal values decreasing over the first few years of life. However, the normal percentage of CD4+ lymphocyte is relatively independent of age. This is reflected in the immune categories of the CDC classification system for HIV infections in children [1] (Table 11.1). Thus, a child of any age with a percentage of CD4+ lymphocytes of less than 15% is considered severely immunosuppressed and a candidate for PCP prophylaxis. In addition, infants have a less effective cellular immune response than do older children (see Chapter 1).
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