Routine pediatric care

doi:10.1017/CBO9780511544798.012

9 - Routine pediatric care

from Part II - General issues in the care of pediatric HIV patients

Published online by Cambridge University Press: 03 February 2010

Elaine Abrams and

Lisa-Gaye Robinson

Edited by

Steven L. Zeichner and

Jennifer S. Read

Show author details

Elaine Abrams: Affiliation:
Associate Professor of Clinical Pediatrics, Columbia University, College of Physicians & Surgeons, Director, Family Care Center, Associate Attending, Harlem Hospital Center, New York, NY
Lisa-Gaye Robinson: Affiliation:
Assistant Professor of Clinical Pediatrics, Columbia University, College of Physicians & Surgeons, Assistant Attending, Harlem Hospital Center, New York, NY
Steven L. Zeichner: Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read: Affiliation:
National Cancer Institute, Bethesda, Maryland

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Summary

Introduction

HIV 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 subspecialists, 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. There are important management considerations that are essential to the care of both children who are exposed to HIV but determined to be uninfected and children with HIV infection.

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. Pediatric providers 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 9.1). 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 section 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).

Type: Chapter
Information: Textbook of Pediatric HIV Care , pp. 134 - 144

DOI: https://doi.org/10.1017/CBO9780511544798.012 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2005

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References

Connor, E. M., Sperling, R. S., Gelber, R.. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. New Engl. J. Med. 331: 18 (1994), 1173–80CrossRef Google Scholar PubMed

Shaffer, N., Chuachoowong, R., Mock, P. A.. Short-course zidovudine for perinatal Human Immunodeficiency Virus-1 transmission in Bangkok, Thailand: a randomized controlled trial. Lancet 353: 9155 (1999) 773–80CrossRef Google Scholar

The PETRA study team. Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of Human Immunodeficiency Virus-1 from mother to child in Tanzania, South Africa, and Uganda (Petra study): a randomised, double-blind, placebo-controlled trial. Lancet. 359: 9313 (2002), 1178–86CrossRef

Guay, L. A., Musoke, P., Fleming, T.. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of Human Immunodeficiency Virus-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 354: 9181 (1999), 795–802CrossRef Google Scholar PubMed

Wade, N. A., Birkhead,, G. S., Warren, B. L.. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. New Engl. J. Med. 339: 20 (1998), 1409–14CrossRef Google Scholar PubMed

The International Perinatal Human Immunodeficiency Virus Group. The mode of delivery and risk of vertical transmission of Human Immunodeficiency Virus-1- a meta-analysis of 15 prospective cohort studies. N. Engl. J. Med. 340: 13 (1999), 977–87CrossRef

The European mode of delivery collaboration. Elective cesarean-section versus vaginal delivery in prevention of vertical Human Immunodeficiency Virus-1 transmission: a randomized clinical trial. Lancet 353: 9158 (1999), 1035–9CrossRef

Cooper, E. R., Charurat, M., Mofenson, L.. Combination antiretroviral strategies for the treatment of pregnant Human Immunodeficiency Virus-1 infected women and prevention of perinatal Human Immunodeficiency Virus-1 transmission. J Acquired Immune Deficiency Syndrome 29: 5 (2002), 484–94CrossRef Google Scholar

Wade, N., Birkhead, G. & French, P. T.Short courses of zidovudine and perinatal transmission of Human Immunodeficiency Virus. New Engl. J. Med. 340 (1999), 1042–3Google Scholar

Centers for Disease Control and Prevention. Guidelines for the use of antiretroviral agents in pediatric Human Immunodeficiency Virus infection, 1998. MMWR 47 (No. Relative Risk-4): 1–43 (updates available at http://AIDSInfo.nih.gov)

Hanson, I. C., Antonelli, T. A., Sperling, R. S.. Lack of tumors in infants with perinatal Human Immunodeficiency Virus-1 exposure and fetal/neonatal exposure to zidovudine. J. Acquired Immune Deficiency Syndrome Hum. Retrovirol. 20: 5 (1999), 463–7CrossRef Google Scholar PubMed

Blanche, S., Tardieu, M., Rustin, P.. Persistent mitochondrial dysfunction and perinatal exposure to antiretroviral nucleoside analogues. Lancet 354 (1999), 1084–9CrossRef Google Scholar PubMed

The Perinatal Safety Review Working Group. Nucleoside exposure in the children of Human Immunodeficiency Virus-infected women receiving antiretroviral drugs: absence of clear evidence for mitochondrial disease in children who died before 5 years of age in five United States cohorts. J. Acquired Immune Deficiency Syndrome 25 (2000), 261–8CrossRef

Cunningham, C. K., Charbonneau, T. T., Song, K.. Comparison of human immunodeficiency virus 1 Deoxyribonucleic Acid polymerase chain reaction and qualitative and quantitative Ribonucleic Acid polymerase chain reaction in human immunodeficiency virus 1-exposed infants. Pediatr. Infect. Dis. J. 18 (1999), 30–5CrossRef Google Scholar

Delamare, C., Burgard, M., Mayaux, M. J.. Human Immunodeficiency Virus-1 Ribonucleic Acid detection in plasma for the diagnosis of infection in neonates. The French Pediatric Human Immunodeficiency Virus Infection Study Group. J. Acquired Immune Deficiency Syndrome Hum. Retrovirol. 15: 2 (1997), 121–5CrossRef Google Scholar

Benjamin, D. K., Miller, W. C., Fiscus, S. A.. Rational testing of the Human Immunodeficiency Virus-exposed infant. Pediatrics 108: 1 (2001), E3CrossRef Google Scholar

Dunn, D. T., Brandt, C. D., Krivine, A.. The sensitivity of Human Immunodeficiency Virus-1 Deoxyribonucleic Acid polymerase chain reaction in the neonatal period and the relative contributions of intra-uterine and intra-partum transmission. Acquired Immune Deficiency Syndrome9 (1995), F7-11

McKinney, R. E. & Robertson, J. W.Effect of human immunodeficiency virus infection on the growth of young children. Duke Pediatric Acquired Immune Deficiency Syndrome Clinical Trials Unit. J. Pediatr. 123: 4 (1993), 579–82CrossRef Google Scholar PubMed

Abrams, E. J., Matheson, P. B., Thomas, P. A.. Neonatal predictors of infection status and early death among 332 infants at risk of Human Immunodeficiency Virus-1 infection monitored prospectively from birth. Pediatrics 96 (1995), 451–8Google Scholar PubMed

Moye, J., Rich, K. C., Kalish, L. A.. Natural history of somatic growth in infants born to women infected by human immuno-deficiency virus. J. Pediatr. 128 (1996), 58–69CrossRef Google Scholar

DeMartino, M., Tovo, P. A., Galli, L.. Puberty in perinatal Human Immunodeficiency Virus-1 infection: a multicenter longitudinal study of 212 children. Acquired Immune Deficiency Syndrome 15: 12 (2001), 1527–34Google Scholar

Arpadi, S. M., Cuff, P. A., Horlick, M., Wang, J. & Kotler, D. P.Lipodystrophy in Human Immunodeficiency Virus-infected children is associated with high viral load and low Cluster of Differentiation4+ -lymphocyte count and Cluster of Differentiation4+ -lymphocyte percentage at baseline and use of protease inhibitors and stavudine. J. Acquired Immune Deficiency Syndrome 27: 1 (2001), 30–4CrossRef Google Scholar

Melvin, A. J., Lennon, S., Mohan, K. M. & Purnell, J. Q.Metabolic abnormalities in Human Immunodeficiency Virus type 1-infected children treated and not treated with protease inhibitors. Acquired Immune Deficiency Syndrome Res. Hum. Retroviruses 17: 12 (2001), 1117–23Google Scholar

Centers for Disease Control and Prevention. Recommended Childhood and Adolescent Immunization Schedule-United States, 2004. MMWR, 53 (2004), Q1–3

Diamond, G. W.Developmental problems in children with Human Immunodeficiency Virus infection. Ment. Retard. 27: 4 (1989), 213–7Google Scholar

Brown, L. K., Lourie, K. J. & Pao, M.Children and adolescents living with Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome: a review. J. Child. Psychol. Psychiatry 41: 1 (2000), 81–96CrossRef Google Scholar PubMed

Mofenson, L. M., Korelitz, J., Meyer, W. A.. The relationship between serum human immunodeficiency virus type 1 (Human Immunodeficiency Virus-1) Ribonucleic Acid level, Cluster of Differentiation4 lymphocyte percent, and long-term mortality risk in Human Immunodeficiency Virus-1 infected children. National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. J. Infect. Dis. 175 (1997), 1029–38CrossRef Google Scholar

Abrams, E. J., Weedon, J., Steketee, R. W.. Association of Human Immunodeficiency Virus viral load early in life with disease progression among Human Immunodeficiency Virus-infected infants. J. Infect. Dis. 178 (1998), 101–8CrossRef Google Scholar

Shearer, W. T., Quinn, T. C., LaRussa, P.. Viral load and disease progression in infants infected with human immunodeficiency virus type 1. New Engl. J. Med. 336 (1997), 1337–42CrossRef Google Scholar PubMed

Palumbo, P. E., Raskino, C., Fiscus, S.. Predictive value of quantitative plasma Human Immunodeficiency Virus Ribonucleic Acid and Cluster of Differentiation4+ lymphocyte count in Human Immunodeficiency Virus-infected infants and children. J. Am. Med. Assoc. 279: 10 (1998), 756–61CrossRef Google Scholar

Dunn, D.Human Immunodeficiency Virus Paediatric Prognostic Markers Collaborative Study Group. Short-term risk of disease progression in Human Immunodeficiency Virus-1-infected children receiving no antiretroviral therapy or zidovudine monotherapy: a meta-analysis. Lancet 362: 9396 (2003): 1605–11Google Scholar PubMed

Centers for Disease Control and Prevention 1999 revised guidelines for prophylaxis against Pneumocystis carinii pneumonia for children infected with or perinatally exposed to human immunodeficiency virus. MMWR 48: Relative Risk-10 (1999)

Centers for Disease Control and Prevention 1999 revised guidelines for prophylaxis against Mycobacterium avium intracellulare in patients infected with human immunodeficiency virus. MMWR 48: Relative Risk-10 (1999)

Havens, J. F., Mellins, C. A. & Hunter, J. Psychiatric aspects of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome in childhood and adolescence. In M. Rutter & E. Taylor (eds.), Child and Adolescent Psychiatry: Modern Approaches. Fourth Edition. Oxford, England: Blackwell (2001), pp. 828–41

Mellins, C. A., Brackis-Cott, E., Dolezal, C., Richards, A., Nicholas, S. & Abrams, E. J.Patterns of Human Immunodeficiency Virus status disclosure to perinatally infected Human Immunodeficiency Virus-positive children and subsequent mental health outcomes. Clin. Child Psychol. Psychia 7 (2001), 101–14CrossRef Google Scholar