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HIV and AIDS

HIV in Infants and Children

In 2005, according to UNAIDS (The Joint United Nations Programme on HIV/AIDS), it was estimated that there were 2.3 million children around the world living with HIV/AIDS. This number represented about 6% of the total world population living with HIV. In 2005, about 90% of children living with HIV lived in sub-Saharan Africa.1

Transmission

About 90% of HIV cases in children are due to "vertical" transmission – transmission from mother to child. Most of these cases of transmission happen during the last trimester of pregnancy, during delivery, or through breastfeeding.2

Testing

Direct Testing is required for HIV in children less than 18 months of age who were born to a mother with HIV, as opposed to tests that just look for the HIV antibody in the patient's blood. Any child above 18 months of age can be tested according to general HIV testing guidelines.2

Signs and Symptoms

Many infants or children living with HIV are known or suspected to be infected because their mother's HIV status is already known. However, some cases in children are not recognized until the child starts to develop symptoms.

In infants and children, signs and symptoms of HIV infection include:

When an individual with HIV begins to progress towards AIDS, they will usually contract opportunistic infections (OIs). OIs are rare infections that affect individuals with suppressed immune systems. Children with HIV are less likely to acquire toxoplasmosis (an opportunistic parasitic disease) than adults. However, children with HIV are susceptible to pneumocystis carinii pneumonia (PCP) and to serious infection due to cytomegalovirus (CMV). Children with HIV are also more likely to develop lymphocytic interstitial pneumonitis (LIP), which is rare in adults. Adults with HIV often develop thrush in their mouths due to candida, a type of yeast, while children with HIV often but can also develop severe diaper rash due to candida.2

Treatment

The principles of antiretroviral treatment are similar for both adults and children. Usually a strong cocktail of drugs should be used in order to prevent the virus from becoming resistant to medication. However, there are special considerations when dealing with children. Some antiretroviral medications are not available in liquid form, and others cause side effects that are less acceptable in children than in adults. An HIV specialist can advise which antiretroviral medications are appropriate for children with HIV.

Many infants who are known to have HIV will not demonstrate any symptoms of HIV until they are toddlers or school-age. However, an HIV specialist might recommend that they be started on medication even if they are asymptomatic, in order to improve their long-term survival and general health. The recommendations for when to begin an antiretroviral treatment regiment in infants and children are based on whether the child has symptoms of HIV, as well as their CD4+ T-cell count/percentage and HIV viral load.3

Monitoring

Children with HIV, like adults, must have routine laboratory tests done every few months to monitor the state of their HIV infection and their immune system. This is done by testing for the number of HIV present in the blood (called viral load test), as well as the number of specific white blood cells called CD4+ T-cells. The CD4+ T-cells are targeted by HIV, and therefore, a low level of these cells in a HIV positive person can mean that the disease is progressing, or that the virus is becoming resistant to certain medications.

In children less than 6 years old, it is important to pay close attention to the percentage of T-cells that are CD4+, since the absolute number of cells can be misleading in small children.

Children with HIV are more likely to have developmental delay and learning disabilities, and should be monitored for difficulty in school. It can be emotionally and psychologically difficult to have a chronic infection like HIV that is often misunderstood, and parents and health care providers should be especially aware of the challenges these children face. Usually at least one of the parents of the child is also HIV-positive, and this can add to the complexity of caring for a child with HIV.3

Sources

  1. Chapter 2 – "Overview of the Global AIDS Epidemic," 2006 Report on the Global AIDS Epidemic, UNAIDS http://www.unaids.org/, December 2006.
  2. "HIV Infection in Infants and Children," The National Institute of Allergy and Infectious Diseases (NIAID), July 2004. http://www.niaid.nih.gov/factsheets/hivchildren.htm  
  3. AIDSinfo: Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection - October 26, 2006. http://aidsinfo.nih.gov/contentfiles/PediatricGuidelines.pdf

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Last Reviewed: Jul 22, 2008

Grace A McComsey, MD Grace A McComsey, MD
Professor of Pediatrics
School of Medicine
Case Western Reserve University