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Care priority and warning signs
Care priority
Link to Care / Initiate Prophylaxis & ART
Red flags
- Signs of severe illness (danger signs, severe classifications like severe pneumonia, severe malnutrition).
- Signs suggestive of advanced HIV disease or opportunistic infection (e.g., persistent diarrhoea, recurrent infections, failure to thrive, oral thrush, lymphadenopathy).
Assessment
- Ask: Has the mother or child had an HIV test?
- If Yes: Note mother's/child's status.
- Confirm positive test result: Positive DNA PCR test in child OR Positive HIV rapid test in a child 18 months or older.
Classification
- Positive DNA PCR test in child OR Positive HIV rapid test in a child >= 18 months -> CONFIRMED HIV INFECTION
Key features
- Definitive positive HIV test result appropriate for age.
- Requires lifelong ART and comprehensive HIV care.
- Requires co-trimoxazole prophylaxis to prevent opportunistic infections.
Management
Non-pharmacological management
- Assess feeding and provide appropriate counselling based on age and ART status (Refer to pages 25-28).
- Provide counselling on disclosure, adherence, psychosocial support.
- Monitor growth and development closely.
- Assess for TB (see page 9).
Pharmacological treatment
- Give Co-trimoxazole prophylaxis daily. Dose: Age 6 weeks - 6 months: 2.5ml syrup (or 1 infant tab). Age >6 months - 5 years: 5ml syrup (or 1 adult tab/2 infant tabs). Start from 6 weeks or at diagnosis if older. Continue lifelong unless stopped based on specific criteria (e.g., immune recovery on ART, national guidelines).
- Link child to Early Infant Diagnosis (EID) / ART Clinic for initiation and continuation of Antiretroviral Therapy (ART) and comprehensive HIV care.
- Treat any existing infections or conditions according to IMCI guidelines.
- Ensure immunizations are up-to-date (follow specific schedule for HIV+ children, e.g., avoid BCG if symptomatic/confirmed positive before vaccination).
Follow-up
- Requires regular, lifelong follow-up at the ART clinic for clinical monitoring, CD4/viral load testing, adherence support, management of side effects or complications.
- Follow up for acute illnesses as per IMCI guidelines.
Counselling points
- Explain the positive HIV result clearly and sensitively.
- Explain the importance of starting and adhering to lifelong ART.
- Explain the importance of daily Co-trimoxazole prophylaxis.
- Provide age-appropriate feeding advice.
- Counsel on preventing transmission if relevant (mother's health).
- Counsel on hygiene and preventing opportunistic infections.
- Emphasize importance of regular follow-up at ART clinic.
- Address psychosocial needs and support systems.
- Advise on assessing for TB regularly.
Differential diagnosis
- HIV Exposed (infant <18m with positive antibody test or mother HIV+)
- HIV Infection Unlikely
- Other immunodeficiency conditions (rare)
Complications
- Opportunistic Infections (Pneumocystis pneumonia [PCP], TB, severe bacterial infections, cryptococcosis, candidiasis etc.)
- Malnutrition / Wasting / Stunting
- HIV encephalopathy / Neurodevelopmental delay
- Malignancies (Kaposi sarcoma, lymphoma)
- Chronic lung disease, heart disease, kidney disease
- Immune Reconstitution Inflammatory Syndrome (IRIS) after starting ART.
Prevention
- Prevention of Mother-to-Child Transmission (PMTCT) interventions.
- Safe infant feeding practices for exposed infants.
- General HIV prevention strategies in the community.
References
IMCI Chart Booklet - Page 8, Page 9 (TB check), Page 14 (Co-trimoxazole), Pages 25-28 (Feeding)