Case Report:

This 18-month-old girl was born to an HIV sero-positive mother.

At the time of delivery, both the mother and child were asymptomatic.
The mother received prophylactic nevirapine but the baby received
none. At birth, the child weighed 2,400 grams. Today, she weighs 7
kilograms. She walks but does not talk. She has had several bouts of
bacterial skin infection and once she had pneumonia, which was
treated with penicillin.

Today her mother brings in the child because she doesn't seem as
active as other children. She notices that her weight is less than the
weight of other girls of the same age.

• Will a rapid HIV test be a reasonably reliable way to determine if this child is
infected with HIV? At what age does maternal antibody generally disappear?

• How would you determine if this child's growth retardation is due to immuno
suppression? Is a simple CD4 count adequate?

• What is the best way to insure that this child has a good chance of survival?
COMMENT/ Explanation:

COMMENT: This child is growth retarded. At the age of 18 months, she should weigh more than 8 kilograms. The history of pneumonia and skin infections is worrisome and might indicate immunosupression. Remember, in most developing countries, the mortality rate of HIV positive (+) children is between 40-50% by the age of two years.

Now that she is 18 months, an HIV rapid test will be a reliable indication of her real HIV status. If it is positive, she should have a CD4 count and a determination of the percentage of CD4 cells of the total lymphocyte count. ARVs should be started. If she is HIV seronegative, then other causes of her growth retardation should be investigated.

Remember that one of the most common causes of the death in a child is the death or illness in the mother. This mother needs to be evaluated with a physical examination and a CD4 count and she should be started on ARVs if appropriate. In addition, she definitely should take cotrimoxazole.