1. PEDIATRIC RETROVIRALINFECTIONDR SREE DEVIPROF .C.K.SASIDHARAN

2. A 14 year old girl brought with c/o P/C: cough 2 weeks fever 2weeks white patches in the mouth 2 weeksHOPI:Cough : insidious onset productive - yellow colored sputum, blood stained + more in recumbent postureFever : intermittent high grade no chills or rigorsOral lesions : white in color not associated with pain gradually increasing in nature 3. PAST HISTORY : Scaly skin lesions over both legs : 3 years Recurrent respiratory infections: 1 years. Similar oral lesions: 1 year. Loose mucoid stools , on & off: 1 year P/H/O febrile seizures was on regular AED`S till 3 years of age. 4. BIRTH HISTORY : uneventful DIET HISTORY :Loss of appetite - 1 year IMMUNISATION HISTORY : Immunised . FAMILY HISTORY : 5. O/E : Afebrile, cachexic,Wt: 35 kg Grade III PEMPallor + Ht : 142cm GradeII stuntingGeneralised lymphadenopathy +Grade III clubbing +Oral thrushDystrophic nail changes,Hypopigmented macules over foreheadScaly plaques over both legs S/E: CVS : s1 s2 normal, No murmurRS : B/L coarse crepitations, bronchial breathing right infrascapular regionP/A : soft, no hepatosplenomegalyCNS: No focal neurological deficits 6. GRADE IIICLUBBING 7. ORALCANDIDIASIS 8. DYSTROPHICNAIL CHANGES 9. INVESTIGATIONS Hb: 8.1 g% TC : 2400cells/cum DC : N68 L28 E3 M1 PLATELETS : 3.3 lakhs Mantoux : Negative HIV ( Elisa ) : Positive Throat swab for fungus : negative Sputum for AFB : negative CXR : B/L basal bronchiectasis CT thorax: B/L bronchiectasis and features of infectivebronchiolitis. B/L hilar and mediastinal lymphadenopathy. 10. DIAGNOSIS: HIV STAGE III 11. DISCUSSIONHIV MODES OF TRASMISSION : Unprotected sex with an infected person Blood to- blood contact Pregnancy Childbirth Breast feeding by HIV positive mothers 12. Babies can acquire HIV infection during: Gestation Labor & delivery Breastfeeding 13. CLINICAL STAGING OF HIV INFECTIONWHO CLASSIFICATION :Stage 1 Asymptomatic Persistent generalized lymphadenopathy 14. Stage 2 Unexplained persistent hepatosplenomegalyPapular pruritic eruptions Extensive wart virus infection Extensive molluscum contagiosum Recurrent oral ulcerations Unexplained persistent parotid enlargement Lineal gingival erythema Herpes zoster Recurrent or chronic upper respiratory tract infections(otitis media, otorrhoea, sinusitis, tonsillitis ) Fungal nail infections 15. Stage 3 Unexplained moderate malnutrition not adequately responding to standard therapy Unexplained persistent diarrhoea (14 days or more ) Unexplained persistent fever (> 37.5oC intermittent or constant, > one month) Persistent oral candidiasis (after first 6-8 weeks of life) Oral hairy leukoplakia Pulmonary TB Severe recurrent bacterial pneumonia Symptomatic lymphoid interstitial pneumonitis Chronic HIV-associated lung disease including bronchiectasis Unexplained anemia (25 >500Mild30 - 35 25 - 30 20 - 25 350 - 499Advanced25 - 29 20 - 24 15 - 19 200 - 349Severe