In general, the management of specific conditions in HIV-infected children is similar to that in other children (see Chapters 3–7). Most infections in HIV-positive children are caused by the same pathogens as in HIV-negative children, although they may be more frequent, more severe and occur repeatedly. Some, infections, however, are due to unusual pathogens.
Many HIV-positive children die from common childhood illnesses, and some of these deaths are preventable by early diagnosis and correct management or by giving routine scheduled vaccinations and improving nutrition. These children have a particularly greater risk for staphylococcal and pneumococcal infections and TB. Saving children’s lives depends on early identification, immediate treatment with ART and co-trimoxazole prophylaxis for those who are HIV-infected.
All infants and children should have their HIV status established at their first contact with the health system, ideally at birth or at the earliest opportunity thereafter. To facilitate this, all areas of the hospital in which maternal, neonatal and child services are delivered should offer HIV serological testing to mothers and their infants and children.
This chapter covers mainly the management of children with HIV/AIDS: diagno- sis of HIV infection, counselling and testing, clinical staging, ART, management of HIV-related conditions, supportive care, breastfeeding, planning discharge and follow-up and palliative care for terminally ill children.