90% of the 1.8 million global cases of paediatric HIV are in Sub-Saharan Africa

Pathophysiology

Mother to child transmission (MTCT)

• Without intervention, between 15-45% of babies born to HIV-infected mothers are infected
• Transmission can occur during pregnancy, delivery, and breastfeeding
• Transmission can be reduced to less than 1% with intervention
  • Maternal lifelong antiretroviral treatment, aiming for undetectable viral load in mum
  • Screen and treat for other STDs, especially herpes
  • Infant prophylaxis with co-trimoxazole for 6 weeks
• Child should be tested at birth, 6 weeks, 9 months, 18 months, then 6 weeks after cessation of breastfeeding

Clinical features

• Recurrent or severe common childhood illnesses e.g. otitis media, diarrhoea
• Recurrent oral candidiasis not responding to treatment
• Recurrent severe bacterial infections e.g. meningitis
• Failure to thrive or growth failure
• Generalised lymphadenopathy, hepatosplenomegaly
• Persistent fever
• Encephalopathy
• Chronic parotitis
• Other conditions suggesting immunosuppression - PJP, Kaposi sacroma, TB, lymphocytic interstitial pneumonia etc.

Investigations

Testing

• Counselling/testing should be offered to:
  • All in countries with generalised HIV epidemics
  • All exposed infants at birth
  • Any infant child with any suspicion of HIV