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Care priority and warning signs
Care priority
Link Urgently to ART Clinic / Initiate Prophylaxis
Red flags
- Any signs of PSBI/Very Severe Disease.
- Signs suggestive of opportunistic infection (severe thrush, pneumonia, diarrhoea).
- Failure to thrive.
- Rapid disease progression.
Assessment
- Ask: Has the mother or child had an HIV test?
- Confirm infant has had a positive HIV virological test (DNA PCR).
Classification
- Infant has positive virological test (DNA PCR) -> CONFIRMED HIV INFECTION
Key features
- Positive DNA PCR test confirms HIV infection in an infant.
- Requires urgent initiation of lifelong ART.
- Requires co-trimoxazole prophylaxis starting at 6 weeks.
Management
Non-pharmacological management
- Link infant URGENTLY to HIV Care/ART clinic for initiation of Antiretroviral Therapy.
- Assess feeding and provide appropriate counselling (balancing benefits of breastfeeding with transmission risk, supporting safe replacement feeding if chosen/appropriate - follow national guidelines).
- Assess for TB.
- Provide psychosocial support to mother/family.
Pharmacological treatment
- Start Co-trimoxazole prophylaxis from 6 weeks of age (or immediately if diagnosed after 6 weeks). Dose: Age 6 weeks - 6 months: 2.5ml syrup (or 1 infant tab) daily. Continue lifelong.
- Initiate ART as per national guidelines under specialist care.
- Treat any current illness according to IMCI guidelines (be aware of increased severity risk).
- Ensure immunizations are up-to-date (BCG usually given at birth unless symptomatic infant; other EPI vaccines as per schedule for HIV+ infants).
Follow-up
- Requires lifelong, regular follow-up at ART clinic for monitoring (clinical, growth, CD4, viral load), adherence support, management of complications.
Counselling points
- Explain the positive HIV result clearly and sensitively.
- Explain the critical importance of starting ART immediately for the baby's health.
- Explain the need for daily Co-trimoxazole.
- Provide detailed counselling on safe and appropriate infant feeding according to national guidelines for HIV-positive infants.
- Emphasize importance of adherence to both ART and co-trimoxazole.
- Counsel on preventing opportunistic infections.
- Address mother's health and ART adherence.
- Assess for TB and counsel on monitoring.
- Link family with support services.
Differential diagnosis
- HIV Exposed
Complications
- Rapid disease progression
- Severe opportunistic infections (PCP, TB etc.)
- Failure to thrive / Severe malnutrition
- Neurodevelopmental delay
- Early death
Prevention
- Effective PMTCT interventions.
- This classification represents a failure of prevention, focus shifts to treatment.
References
IMCI Chart Booklet - Page 36 (Classification), Page 37 (Management Principles), Page 14 (Co-trimoxazole reference)