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Treatment of LIP

O Give oxygen therapy during episodes of hypoxia.

O Give a trial of antibiotic treatment for bacterial pneumonia before starting treatment with prednisolone.

O Start treatment with steroids only if there are chest X-ray findings suggesting lymphocytic interstitial pneumonitis, plus any of the following signs:

— fast or difficult breathing

— cyanosis

— pulse oximetry reading of oxygen saturation < 90% (normal value is > 93%).

O Bronchodilators (e.g. salbutamol) are of benefit where wheezing is a problem. For moderate symptoms give oral prednisone, 1–2 mg/kg daily for 3 days, and for more severe symptoms for up to 4 weeks. Then slowly decrease the dose over 2–4 weeks depending on the treatment response. If there is no response by 4 months, slowly taper the dose to stop over a further 2 months.

O Only start steroid treatment if it is possible to complete the full treatment course (which may take several months depending on the resolution of signs of hypoxia), as partial treatment is not effective and could be harmful. Beware of reactivation of TB.

Tuberculosis (see also Section 6.1.N)

In a child with suspected or proven HIV infection, it is important always to consider the co-diagnosis of tuberculosis, a diagnosis which is often difficult. Early in HIV infection, when immunity is not impaired, the signs of tuberculosis are similar to those in a child without HIV infection. Pulmonary tuberculosis is still the commonest form of tuberculosis, even in HIV-infected children. As HIV infection progresses and immunity declines, dissemination of tuberculosis becomes more common. Tuberculous meningitis, miliary tuberculosis and widespread tuberculous lymphadenopathy occur.

All children with HIV should be screened for TB.

Avoid, if practicable, children with HIV being in contact with a TB-infected person.



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