Posted by: Indonesian Children | June 14, 2009

HIV IN CHILDREN : PROGNOSIS

 

  • Hematologic disturbances such as anemia, thrombocytopenia, and neutropenia increase the risk of complications and mortality. Resolution of anemia improves the prognosis, and the treatment of anemia with erythropoietin improves survival. Neutropenia significantly increases the risk of bacterial infection, and treatment of neutropenia with G-CSF significantly decreases the risk of bacteremia and death.
  • MAC has been shown to hasten death, especially with coexisting anemia defined by a hematocrit level less than 25%.
  • The following factors are associated with rapidly progressive disease in infants:
  • Advanced maternal disease 
  • High maternal viral load 
  • Low maternal CD4 count 
  • Prematurity 
  • In utero transmission 
  • High viral load within the first 2 months of life 
  • Lack of neutralizing antibodies 
  • P24 antigen presence 
  • AIDS-defining illnesses 
  • Early CMV infection 
  • Early neurologic disease 
  • Failure to thrive 
  • Early-onset diarrhea
  • Each logarithmic decrease in the viral load after therapy initiation decreases the risk of progression by 54%.
  • Overall progression and prognosis is followed up by using the CDC classification system for children infected with HIV. Both a clinical category letter and an immunologic number determine each stage of disease progression.
  • The clinical categories are determined by the presence of clinic manifestations listed in the letter category (see Table 6), and the immunologic category is based on the age-dependent CD4 count (see Table 7).
  • Once an advanced class is assigned, the disease cannot be reassignment to a lesser class, even if the clinical or immunologic manifestations resolve.
  • Category C and clinical manifestations of advanced disease are synonymous with AIDS.Table 6. CDC Clinical Categories for HIV-Infected Children

     

    Category Manifestation
    N – Asymptomatic One of the manifestations in category A or no symptoms listed in the other categories
    A – Mildly symptomatic Two or more: dermatitis, hepatomegaly, lymphadenopathy (>5 mm at multiple sites), splenomegaly, parotitis
    Recurrent or persistent sinusitis, otitis, or upper respiratory infection (URI)
    B – Moderately symptomatic Invasive bacterial infection
    Persistent (>2 mo) oropharyngeal candidiasis (patients aged >6 mo)
    Cardiomyopathy
    Congenital CMV infection (onset before patient aged 1 mo)
    Chronic or recurrent diarrhea
    Persistent (>1 mo) fever
    Persistent (>1 mo) hematologic disorders
    Anemia (<8 mg/dL)
    Neutropenia (<1000/mm3)
    Thrombocytopenia (<100,000/mm3)
    Hepatitis
    HSVinfection
    Recurrent (>2 episodes/y) stomatitis
    Multiple dermatomes or recurrent (>2 episodes) zoster infection
    Early-onset (patient aged <1 mo) bronchitis, pneumonitis, or esophagitis
    Leiomyosarcoma
    Lymphoid interstitial pneumonia
    Pulmonary lymphoid hyperplasia complex
    Nephropathy
    Nocardiosis
    Congenital toxoplasmosis (patient age a onset <1 mo)
    Disseminated varicella
    C – Late symptomatic Pulmonary or esophageal candidiasis
    Coccidioidomycosis
    Extrapulmonary cryptococcosis
    Cryptosporidiosis
    CMV infection
    Histoplasmosis
    Chronic mucocutaneous HSV infection
    Encephalopathy
    Isosporiasis
    KS
    Lymphoma
    MAC infection
    Mycobacterium kansasii infection
    PCP
    Recurrent pneumonia
    Progressive multifocal encephalopathy
    Salmonellosis
    TB
    Toxoplasmosis
    Late disease MAC infection
    Disseminated CMV retinitis
    Cryptococcal meningitis
    Dementia, histoplasmosis
    Disseminated CNS lymphoma
    Progressive multifocal leukoencephalopathy (PML)
    Wasting syndrome

    Table 7. CDC Immunologic Categories for HIV-Infection in Children by Absolute CD4 Count

     

     

     

    Category Patient Age, >12 y Patient Age, 6-12 y Patient Age, 1-5 y Patient Age, <1 y
    1 – No suppression >500 (>29) >500 (>24) >1000 (>24) >1500 (>24)
    2 – Moderate suppression >200 (>13) >200 (>14) >500 (>14) >750 (>14)
    3 – Severe suppression <200 (<14) <200 (<15) <500 (<15) <750 (<15)

    Note: Data are the absolute CD4 count X 109. Data in parentheses are percentages.

 

 

Supported by

FIGHT AGAINST  AIDS, SAVE  INDONESIAN CHILDREN

YUDHASMARA FOUNDATION

JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210

PHONE :62 (021) 70081995 – 5703646

Email : judarwanto@gmail.com 

https://childrenhivaids.wordpress.com/ 

 

Editor in Chief :

DR WIDODO JUDARWANTO

email : judarwanto@gmail.com,

 

Copyright © 2009,  FIGHT AGAINST  AIDS, SAVE  INDONESIAN CHILDREN  Information Education Network. All rights reserved.


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