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Pediatric HIV
Diagnosis/Definition
HIV infection is defined by evidence of infection with the HIV virus. AIDS is a clinical definition describing symptomatic infection with HIV as defined by criteria published and set forth by the CDC.
Initial Diagnosis and Management
- A child should be suspected of HIV or other immunodeficiency if he/she has more than 2 serious systemic infections with common bacterial pathogens (e.g., meningitis, sepsis, overwhelming pneumonia), more than ten/year significant upper respiratory tract infections (e.g., otitis/sinusitis), herpes-zoster or any infection with an opportunistic or unusual pathogen.
- Other signs and symptoms include failure to thrive, neurological abnormalities or developmental delay/regression.
- Historical factors prompting an evaluation would include a history of blood transfusion, Factor VIII infusion, or Maternal/Paternal IV drug use, homosexual activity, sexual promiscuity, identification as HIV infected.
- Children should have a thorough history and physical performed by the primary care provider to exclude anatomical causes, underlying chronic disease, or inaccurate history.
Ongoing Management and Objectives
Not applicable.
Indications for Specialty Care Referral
If the history and physical taken by the primary care provider is suggestive of an immunodeficiency, and underlying causes are excluded, the patient should be referred to the Pediatric I.D. Clinic for an intake evaluation on a routine basis. HIV serology can be obtained either before the referral or by Pediatric I.D. Clinic.
All patients who are HIV infected should be referred to the Pediatric I.D. Clinic.
Criteria for Return to Primary Care
If the patient is determined not to be immunodeficient after consultation by Pediatric I.D., then they will be returned to primary care without any further follow-up. If HIV or another immunodeficiency is identified, appropriate follow-up and management of the disorder will be provided by Pediatric I.D., and routine care will remain with the primary care provider.
