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A 9-year-old HIV-infected boy presented with fever and fatigue for 2 months.

A 9-year-old HIV-infected boy presented with fever and fatigue for 2 months. He is not on ART. His last CD4, previous 6 months, was 300 cells/cu.mm. His father died from AIDS 2 years ago. 1. What is your prefer investigation for fever? A. Hemoculture B. Chest X-ray

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A 9-year-old HIV-infected boy presented with fever and fatigue for 2 months.

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  1. A 9-year-old HIV-infected boy presented with fever and fatigue for 2 months. • He is not on ART. His last CD4, previous 6 months, was 300 cells/cu.mm. His father died from AIDS 2 years ago. 1. What is your prefer investigation for fever? A. Hemoculture B. Chest X-ray C. Tuberculin skin test D. Bone marrow aspiration

  2. His CXR showed

  3. He had no cough and could not collect sputum. 2. What is the investigation to identify causative organism? A. Bronchoscopy B.Induce sputum C. Gastric aspiration D. Lung aspiration

  4. In case of all investigation could not demonstrate organism. 3. What is your treatment decision? A. Treat PCP B. Treat pulmonary TB C. Treat both bacterial pneumonia and TB D. Treat bacterial pneumonia and follow CXR 2 weeks later

  5. He was clinically stable. This visit, CD4 and VL were 100 cells/cu.mm. and 80,000 copies/ml. 4. When will you start ART? A. immediately B. 2 weeks after anti-TB C. 8 weeks after anti-TB D. after complete anti-TB course

  6. 5. What is your ARV prescribed regimen? A. 3NRTIs B. 2NRTIs + EFV C. 2NRTIs + NVP D. 2NRTIs + LPV/r

  7. He was clinically stable. This visit, CD4 and VL were 100 cells/cu.mm. and 80,000 copies/ml. If he is now on AZT/3TC/LPV/r because of failing NNRTI-based regimen 6. What is your antituberculous drug treatment? A. Continue ARV and start IOZE B. Change to 3NRTIs and start IRZE C. Double dose of LPV/r and start IRZE D. Stop ARV and start IRZE for 2 months

  8. For the persistent infection of HBV in children. 1. What is the most important factor? A. Sex B. HBV genotype C. Age at infection D. Maternal HBV DNA

  9. Risk of developing chronic HBV • Age at time of infection : Neonate (mother HBeAg+) up to 90% : After neonate – 5 years 20-30% : Immunocompetent adults < 5-10% • Maternal HBeAg/anti-HBe status : < 10% - HBeAg -ve/anti-HBe +ve

  10. A 13-year-old boy with HIV/HBV co-infection, his CD4 count is 200 cell/cu.mm., ALT 15 IU/ml., HBeAg –ve, HBV DNA 106 copies/ml 2. What is the preferred NRTI backbone? A. TDF/3TC B. AZT/3TC C. AZT/ABC D. TDF/AZT

  11. Phases of chronic HBV infection

  12. A 12-year-old with a complete history of HBV immunization since infancy period Hepatitis B profilebefore ART initiation showed negative for anti-HBs, anti-HBc and HBsAg. 3. How many shot(s) of HBV vaccine is needed? A. 0 B. 1 C. 2 D. 3

  13. Booster response in HIV children • 64 HIV-infected children : median age - 10 years : median cART - 31 months : complete HBV vaccination : no seroprotective Ab – 87% • Seroprotective Ab after booster : 17.0% after 1st dose : 82.5% after 2nd dose : 92.0% after 3rd dose Lao-Araya M, et al. Vaccine 2011;29:3977-81.

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