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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question Category : HIV
What are the indications of steroids in henoch shonle in purpura? Can we get soft liver with sharp borders and firm liver with rounded borders? What is the criteria for remission in acute lymphatic leukemia? Why is there palmar erythema and parotid swelling in chronic liver disease? What is the etiology of recurrent parotitis in HIV? Why step ladder type of fever is not seen in pediatric typhoid? Which is the most suitable antifungal in treatment of febrile neutropenia? Check Out the Answer
Question Category : HIV
Lot of anti sickling agents have been mentioned in books besides butyrates .But further information is not available in latest journals or textbooks. Kindly discuss it. 2) We have a case of neonatal thrombocytopenia which I am mentioning briefly. Mother HIV +VE, totally asymptomatic except moderate splenomegaly. Platelet count 72000/mm, delivered be cesarean. Baby brought for routine follow up on 2nd week of life. THROMBOCYTE count 52000 . Baby was called for follow up for every week. Her count was 50000 & 16,000 (sixteen thousand) respectively. Baby was totally asymptomatic at all visits. PBS SHOWS GIANT PLATELETS BUT COAGULATION PROFILE NORMAL. WHAT SHOULD BE FURTHER plan of action? Is anti platelet antibodies test necessary? Should we transfuse the baby or give steroids? Is mother or baby's bone marrow indicated? (if any further info required please let me know) Check Out the Answer
Question Category : HIV
Is it possible for the second child in a set of twins to be infected with HIV virus during birth from the Mother and the first twin to be normal? The second baby came after 5 minutes on arrival of the first baby. They were delivered normally and they both weighed 3.5 and 3.4 respectively. Check Out the Answer
Question Category : HIV
Can one set of twins be HIV positive and the negative? Check Out the Answer
Question Category : HIV
What is the cause of gross wasting in HIV? Check Out the Answer
Question Category : HIV
For prevention of mother to infant transmission of HIV various trials are used like THAI, ACTG076 & HIVNET. But few physicians and gynecologist use combination therapy like DUOVIR (zidovidine+lamividine OR these two +stavudine or nevirapine DURING ANTENATAL period.(Of course that is justifiable) I want to know what retroviral drug to be given to infant of HIV positive mothers when various such combinations are used? 2)A request-"Question of the day" is a section where we can read other doctor's answers and opinions and it is definitely nice to know others views. But it will be also useful if you add expert's answer for that particular question. Thanking you Yours sincerely Mangesh. Check Out the Answer
Question Category : HIV
What drug can one prescribe for a 5 years old HIV positive child who is on TB treatment but has no appetite for food and when forcefully fed, the child vomits all that she ate. Check Out the Answer
Question Category : HIV
Any online reference about WHO clinical case definition of HIV in children? Whether case definition issued for adults can be applicable to children also i.e. 2 major & 2 minor criterias. Check Out the Answer
Question Category : HIV
IAP has given guidelines for management of HIV (pcr positive) infants and children which depends on either CD4 COUNT VIRAL LOAD OR CLINICAL STAGING.(A,B OR C) the problem is every time it is not possible to get viral load or CD4 count as they are costly .And depending on clinical staging only it is difficult to treat as co relation of low cd4 count and infection may not be there. I mean they can be relatively asymptomatic. On the other hand Nelson mentions that every PCR positive infant should be treated irrespective of viral load and cd4 count. Please comment. Check Out the Answer
Question Category : HIV
A 2 month old child came with h/o of poor weight gain and fever for 2 weeks. The child was found to have generalized lymphadenopathy and malnourished, no BCG scar, hepatosplenomegaly. Otherwise all work outs are normal. Mother found to be retroviral positive and the child does not have a BCG scar. Can disseminated BCG tuberculosis be a differential diagnosis. How to confirm? Check Out the Answer
Question Category : HIV
Dear sir, I have a child who is a known case of HIV +ve since two years and is on septran prophylaxis. she is put on 3 drug ART since 6 months (lamuvudine ,zidu,nevirapine) presented with pancytopenia and low retic counts .suggesting bone marrow supression .please tell me what shall I do next about the ART and how do I treat other than giving a transfusion for the anemia. What is the role of GCS in these children. Her CD4 counts are very low and her age is 6 yrs. Check Out the Answer
Question Category : HIV
This is regarding pediatric HIV 1)IAP has recommended few simple measures to reduce breast milk HIV transmission like a-keep ebm standing for few hours b-boiling and pasteurizing breast milk c-freezing. My question is how much feasible and useful they are ? Do they really reduce the viral load to significant extent/ what is your experience? 2) I am working in an HIV project where we regularly do baseline investigation and DNA PCR the trial is related to nevirapine where we give 6 week nevirapine in babies enrolled in randomized cohort. It has been observed that many babies develop anemia or neutropenia or both where neither of these side effect has been mentioned as per as i know. Will you please guide me? 3) Does mother receiving zidovidine antenataly will cause anemia in baby? Check Out the Answer
Question Category : HIV
If a neonate born to HIV positive mother tests negative for HIV ELISA,can it be safely ruled out that baby is HIV Negative? Check Out the Answer
Question Category : HIV
8 year old male patient known case of retro viral positive , whose count was only 5 was put on zidovudine,lamivudine and stavudine for 2 years. I knew that the combination of zidovudine and stavudine should not be used..so immediately I changed to zidovudine , nevirapine and lamivudine. I wanted to change 2 drugs but I changed 1 drug only as patient could not afford. Patient was alright for 1 year but now he is loosing weight from 25 to 21 now..But is symptom free. Please suggest me what am i suppose to do... Check Out the Answer
Question Category : HIV
Monotherapy role of lamivudine in hiv...any new therapy? Check Out the Answer
Question Category : HIV
10 days old abandoned neonate. Parents not known.HE was admitted to an orphanage. Orphanage people are doing HIV ELISA for all admitted babies to them. They are not doing DNA pcr FOR CHILDREN BELOW 18 MONTH as they can not afford it. The above said neonate turned to be ELISA +VE. The pediatrician of the orphanage started him on zidovidine.(i.e prophylaxis) My question is that is it correct to start baby on zidovidine prophylaxis when mother status is not known . 2)Doing PCR or Elisa (WHICHEVER APPLICABLE )ROUTINELY OF ALL admitted patient. Check Out the Answer
Question Category : HIV
Can we use combination of nevirapine and rifampicin by increasing the dose of nevirapine. If not why? Check Out the Answer
Question Category : HIV
Please tell me if a patient has received ART in the past and has stopped it, how does one approach? Are there some guidelines? This will be a long answer as this will involve various factors. Sachin d Check Out the Answer
Question Category : HIV
Respected sir, I AM FORWARDING HERE WITH my query and your answer to that. Please refer to the second question. I have asked to you regarding which I am writing. What is side effect of NEVIRAPINE. IN OUR PROJECT WE ARE GIVING 6 WEEKS NEVIRAPINE ONLY TO PCR NEGATIVE babies and not as ART TO positive babies. My Q was in our project many babies got neutropenia. As GRANULOCYTOPENIA has been mentioned as very rare side effect and that also in very few articles.So does nevirapine really leads to neutropenia. Sorry for asking the Question again. Check Out the Answer
Question Category : HIV
A 12 year old female, HIV positive, presented with progressive abdomen distention since a year and severe short stature. No history s/o CNS, CVS or hematological system involvement. h/o admission for 7 days at 6 yrs of age for fever(details not available). Father died of kochs 5 yrs back. Mother died postpartum younger sib also expired. Patient is severely short statured height age-6yrs wt 17 kg. huge (17cm) spleen. Left lobe liver palpable 5 cms in mid sternal line. hb 6, p/s-hypo micro,wbc and plt--wnl. bili 1.3.bone age >12yrs. osteopenia on X-ray. What working diagnosis to keep in this case?? How to investigate further? Check Out the Answer

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