UgandAshis 35 Pediatrics III

UgandAshis 35 Pediatrics III

July 14, 2009

Fort Portal, Uganda

What happens to a child with HIV/AIDS?

Well in theory all children have access to government service called the Joint Clinical Research Centers. What needs to happen are in a simplified and summarized explanation:

1. Diagnosis needs to be confirmed by a blood test after voluntary counseling and testing for the parents as well as the child. Given mother to child transmission is the most common route to develop HIV/AIDS mother and father need to be counseled. Often the diagnosis of mother and father is made when a child falls ill.

2. Once the diagnosis is made a work up is done using certain blood values (CD 4, total blood count) and/or clinical impression WHO HIV/AIDS criteria by a doctor. The grades range from I-IV depending on which group your symptoms can be classified the child will fall into the inclusion criteria for receiving Highly Active Anti Retroviral Therapy (HAART)

3. Before treatment is started underlying opportunistic infections (e.g. tuberculosis) need to be treated. Due to drug interactions between HAART and anti tubercular drugs (ATB) TB is treated first.

4. Prophylaxis (oral antibiotics, cotrimoxazole) is given to avoid diarrheal disease (Isospora belli, Cryptosporidium) and pneumonia (Pneumocystis carinii)

5. Emphasis is given to proper feeding. A nutritionist explains what are the high energy good quality food sorts to combat the illness.

6. Treatment with HAART is started and monthly the blood values are checked and follow up and treatment of opportunistic infections is done.

7. Common malignancies as Kaposi sarcoma and lymphoma are actively searched for.

8. Common infections as oral thrush (Candidiasis) are treated.

9. Psychosocial support is organized for the patient and its relatives. Destigmatization of HIV/AIDS is still needed. Joining groups of People Living with HIV/AIDS (PLWHA) is advised.

10. If and when a good family support system exists a child can live for years on treatment. Reaching child bearing age which then leads to a whole new set of steps to be taken.

11. Many of the children I see are the exception. Too many children die undiagnosed and untreated as the hospital is out of reach of their parents. Remember this referral hospital services 2.5 million people and has a mere 400 beds.

12. Conservative estimates point to 1 million HIV/AIDS infected in Uganda. At least 25% are children. Also there are many HIV/AIDS orphans. HIV/AIDS has been around in Uganda for decades.

Namaskar,

Ashis