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In fact, ART is the only treatment shown to be effective against some of the causes of diarrhoea in HIV. These should reduce the risk of diarrhoea and of poor outcomes related to the condition. This is especially true of initial case management, although children with HIV and persistent diarrhoea who do not respond to IMCI’s case management protocols may require further diagnostic investigations (see below).Īlso, early infant HIV diagnosis could lead to the earlier detection of children with HIV and the provision of an effective antiretroviral therapy (ART) regimen and other HIV care for both infant and mother. These developments should benefit children with HIV as well - in fact, UNICEF and the IMCI guidelines assert that case management should be the same whether the child is HIV-infected or not.
In addition, there has been a recent push from global health activists who are advocating for wider access to effective treatment and preventive interventions - as well as improved access to safe drinking water, sanitation and hygiene. Secondly there is wider promotion of simple interventions (such as vitamin A and zinc supplementation) that should improve survival - especially oral rehydration therapy (ORT) for the management of dehydration related to diarrhoea. 8īut over the last several years, much has changed that should improve the outlook for children at risk of diarrhoea - including those with HIV.įirst, many programmes have adopted the very clear guidelines and algorithms for the management of acute diarrhoea produced by WHO’s Integrated Management of Childhood Illness (IMCI) project. 7 Even so, persistent diarrhoea is considered to be a marker for rapid progression of HIV disease. Persistent diarrhoea contributes to mortality causing malnutrition and wasting that weaken the child - and one study found that persistent diarrhoea was eleven times as likely to be associated with death in children with HIV than in those without, although other concurrent complications could also be contributing factors. 1 Around 40% of these deaths occur in Africa.
She also wants to relieve the child’s discomfort.ĭiarrhoea is the second leading killer globally of children of under five (after pneumonia), responsible for nearly one in five childhood deaths (~1.5 million each year). The nurse recognises that she will need to treat Thandi for persistent diarrhoea and address the child’s malnutrition, but she is also fairly certain she will have to test and treat HIV as well (and broach the subject of HIV to the grandmother). She also has a severe diaper rash that looks painful, a low-grade fever, oral thrush, and generalized lymphadenopathy. A short while after her mother’s death Thandi developed diarrhoea, which has lasted for a couple of months, and she is quite small and frail for her age. Her grandmother says that her mother died a few months ago of tuberculosis (TB). Thandi is 10 months old when her grandmother brings her into the clinic because she has diarrhoea.
Diarrhoea a major cause of death in children with HIV This clinical review is kindly supported by the Diana, Princess of Wales Memorial Fund.