HIV and PMTCT factsheet Nepal : High yield

Epidemiology

• First reported human immunodeficiency virus (HIV) infection in Nepal in 1988
• Individuals infected with HIV-16,262 ((NCASC; August 2010 data).
• The most recent population based estimates (NCASC, 2009) – 63,528 adults and children
• Estimated prevalence of 0.39% in the adult population.
• During 2009, an estimated 4,701 adults and children died from Acquired Immune Deficiency (AIDS) related causes.
• Almost 29% of all people living with HIV (PLHIV) in Nepal are women. Among women, 90% of
• reported cases are of childbearing age (15-49 years age group).

Most At-Risk Populations

Nepal is described as having a “concentrated” HIV epidemic, where the estimated prevalence of
HIV infection in identified most at-risk populations (MARPs) – e.g. injecting drug users (IDUs)–
consistently exceeds 5%.
Recent estimates are that 29% of all infections occur among seasonal labour migrants, 5% among
clients of sex workers, and 28% among “low risk females” (NCASC, 2009)

HIV Infection in Women and Children
Mother-to-child transmission (MTCT) is by far the largest source of HIV infection in children in
Nepal.
The HIV seroprevalence rate among pregnant women is estimated to be 0.2%.

Based on this estimate, 1,228 (0.2%) of the 798,174 pregnancies each year may be expected to occur in HIV positive women. Based on an assumed vertical transmission rate of 25-45%, the annual birth
cohort of potentially infected newborns would be 307-552.

It is estimated that there are 3,544 children living with HIV in Nepal. Of these, only 1,037 have been
reported (NCASC, August 2010).

High Yield Facts-

1. PMTCT service started in Feb 2005 and now has 21 PMTCT sites.

2. Diagnostic test of choice for HIV in children <18 months- DNA PCR

3. HIV antibody testing ELISA- 100% sensitive 99% specific

4.Two positive Antibody test needed to confirm the diagnosis.

5. Pneumocystis is commoner in younger age group children and LIP in more than 2 yrs children.

Differences in pediatric and adult HIV

1. Overall progression is more rapid in children
2. Immune system is immature with higher CD4+ counts
3. Recurrent invasive bacterial infections more common
4. Disseminated CMV, candida, herpes, varicella are more common in children
5. LIP occurs exclusively in children
6. CNS infections are more common
7. Peripheral neuropathy, myopathy and Kaposi sarcoma are rare in children.

Guidelines- PMTCT

Must read Guidelines – Download PMTCT guidelines and Management of HIV and AIDS in children in Nepal 2011.