European Association of Nurses in AIDS Care
8th Annual Conference - AD 2000: Advances in AIDS Care, September 1997
Key points of session - Women and Children with HIV - Jacqueline Mok
Notes taken and webplaced by Ian Hodgson on 22.10.97
- within the family, the child developing PCP is often the 'index' case - the first in the family to be found HIV+ve
- supportive care will include: terminal care (long term); nutrition; immunisation (all except BCG); prophylactic therapy, plus anti-viral treatment
- early treatment is beneficial, because: i) the virus is 'homogenous' and not drug resistant; ii) the half life of the virus (the time it takes to double its 'volume') is 2 days, with up to 1bn viral particles being produced per day
- HIV infection is becoming much more of a chronic illness - 90% of children survive 1 year following diagnosis -72% survive up to 5 years following diagnosis
- consequences of this: cannot ignore child !; physically - weight loss, failure to thrive, repiratory problems, opportunistic infections, usual childhood infections amplified; mental health - stigma and isolation, effects of chronic illness, effects of cerebral disease; sexual health - safer sex, reproductive choices; palliative care - provide information, pain control
- preparation for death - house or home ?, parents may wish to keep a 'memory box', will, funeral arrangements (discuss with child) - where will teddy go ?
- legal and ethical issues - issues around confidentiality (does the child know how they became infected ?), consent to treatment (whose choice ?)
- talking with the children - reassure and build trust, help them maintain self confidence, and keep control, help them prepare for the death of one or both parents (extremely likely during the child's lifetime)
- children 'affected' by HIV (ie. in families but not HIV+ve) in UK currently 4039
- many are in foster care, though African communities have support networks allowing 'kin' to care for the children
- factors increasing risk of mother to child (vertical) transmission - biological and genetic mutations result in some HIV infections being more aggressive; high viral load and low CD4 counts; presence of another STD; long labour or early membrane rupture
- action to lessen risk of vertical transmission - caesarean section; treatment of STD; anti viral treatment (need to know HIV status first - argument for screening ?) can reduce by 2/3rds
- e given according to viral load, not CD4 count; if viral load climbs, change treatment