HIV in Children
May 2016 NEWSLETTER


HIV IN CHILDREN
May 2016 Newsletter
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GRAND ROUNDS
An 11 years old HIV infected girl was referred for further management. Her CD4 count was 188 cells/cumm. CBC showed thrombocytopenia (Hemoglobin = 11 gm/dl, WBC = 5,700/cumm, platelets = 30,000/cumm). She was started on 3 drugs ART consisting of zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP) along with trimethoprim-sulphamethaxole prophylaxis. On follow up after 3 months, she had a weight gain of 1 kg but continued to have thrombocytopenia and even after 6 months, thrombocytopenia persisted.

Why is her thrombocytopenia not responding to ART?

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Question Of the Day
Q. We have a 9 yr old retroviral positive girl admitted with epistaxis, with platelet count of 4000; treated as per the protocol with methyprednisolone and platelet transfusion,temporarily platelet count improved to 23,000 after 2 days, following which steroids were stopped.
Child also had anemia and I/v/o zidovidine induced anemia,changed to abacavir regimen. Within 4 days child again developed epistaxis,and the platelet count was 3000;and child had signs of severe blood loss, hence received PRBC's, platelet transfusion along with methylprednisolone pulse theraphy for 5 days; following which platelet count improved to 35000.
Meanwhile her CD4 count is 245. She also gives past history of epistaxis 4 months before which stopped by itself. Our working diagnosis was chronic ITP. Kindly guide us regarding the management of chronic ITP in hiv positive children and also on the concern regarding duration of steroid treatment in them as they are immunosuppressed.
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Pediatric Oncall Book Store
NEW ARRIVAL
Infection in Children - Part 2

By Dr. Ira Shah
Case Rounds in Pediatric Liver Disorders
By Dr. Ira Shah
Tuberculosis
By Dr. Ira Shah
Management of Pediatric HIV
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Infection in Children
By Dr. Ira Shah