HIV in Children
September 2015 NEWSLETTER


HIV IN CHILDREN
September 2015 Newsletter
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GRAND ROUNDS
A 9 years old girl presented with left sided hemiparesis for 8 months and loss of vision & bladder and bowel control for past 3 months. CT brain showed right middle cerebral artery infarct and CSF examination was normal. Her HIV ELISA was positive at that time. She was started on antituberculous therapy (ATT) by the attending physician. However she had no clinical improvement. On presentation, we did her MRI brain which showed severe cerebral atrophy with bilateral subdural fluid accumulation with bilateral internal cerebral artery (ICA) occlusion with diffuse narrowing of the vertebro-basilar arteries and non-filling of the middle and anterior cerebral artery mainstem with extensive infarction within the cerebral cortex bilaterally with acute lesion in the occipital lobe suggestive of multiple infarcts in various stages of development. Thrombotic workup showed Protein C [52% (Normal = 70-140%)], Protein S [66% (Normal = 70-140%)]. Her CD4 count was 59 cells/cumm (2.92%). She was started on 3 drug ART in form of zidovudine (AZT), lamivudine (3TC) and efavirenz (EFV) along with aspirin and warfarin. She did have an improvement in her vision over a period of 3 weeks. Two months later, she again presented with seizures and fever. CT brain showed right subdural hematoma which was evacuated by surgical intervention and aspirin and warfarin were withheld. She has been continued on her ART but there is no clinical improvement.

What are the causes of thrombosis in HIV infected children?

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Question Of the Day
Q. A 10 year old female child is newly diagnosed as hiv positive. She has completed ATT 5 yrs back. Her cd4 count is 426. She is asymptomatic for tuberculosis. Should we start ART in this child?
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Pediatric Oncall Book Store
NEW ARRIVAL
Infection in Children - Part 2

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Tuberculosis
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Management of Pediatric HIV
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Infection in Children
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