AIDS/HIV in Children
What is HIV?
Human immunodeficiency virus (HIV) is the virus that is responsible for causing acquired immune deficiency syndrome (AIDS). The virus destroys or impairs cells of the immune system and progressively destroys the body's ability to fight infections and certain cancers. In adults and adolescents, HIV is most commonly spread by sexual contact with an infected partner. In the U.S., nearly all HIV infections in children under the age of 13 are from vertical transmission, which means the virus is passed to the child when they are in their mother's womb or as they pass through the birth canal, or through breastfeeding. Before 1985, a small group of children were infected with the virus by contaminated blood products. Routine screening of blood products began in 1985. Not every child born to an HIV-infected mother will acquire the virus.
In the U.S., teens and young adults between the ages of 13 and 24, especially among minority groups, represent one of the fastest growing HIV-positive groups.
The number of infants who become HIV positive when born to an infected mother has decreased. This reduction reflects the use of new anti-retroviral medications that are given to the mother before her baby is born, and given to the baby after birth. Because transmission often occurs during delivery, cesarean section may be indicated for some women.
How is HIV transmitted or spread?
The following are the means by which the HIV virus is spread:
Vertical transmission. HIV can be spread to babies born to, or breastfed by, mothers infected with the virus.
Sexual contact. In adults and adolescents, HIV is spread most commonly by sexual contact with an infected partner. The virus enters the body through the lining of the vagina, vulva, penis, rectum, or abraded or irritated tissues in the lining of the mouth through sexual activity.
Blood contamination. HIV may also be spread through contact with infected blood. However, due to the screening of donated blood for evidence of HIV infection, the risk of acquiring HIV from blood transfusions is extremely low.
Needles. HIV is frequently spread by sharing needles, syringes, or drug use equipment with someone who is infected with the virus. Transmission from patient to health care worker, or vice-versa, through accidental sticks with contaminated needles or other medical instruments, is rare.
No known cases of HIV/AIDS have been spread by the following:
Casual contact, such as sharing food utensils, towels, and bedding
Biting insects (such as mosquitoes)
What are the symptoms of HIV?
The symptoms vary depending on the age of the child. The following are the most common symptoms of HIV infection. However, each infant, child, or adolescent may experience symptoms differently. Symptoms may include:
Infants. At birth, infants born to an HIV-infected mother may test negative for the virus and have no symptoms. This does not mean that the infant does not have the virus. Blood tests will be done at various stages after birth up to and past 6 months of age to determine an infant's HIV status. Symptoms may include the following:
Failure to thrive. Delayed physical and developmental growth as evidenced by poor weight gain and bone growth.
Swollen abdomen. This is due to swelling of the liver and spleen.
Swollen lymph nodes
Intermittent diarrhea. Diarrhea that may come and go.
Oral thrush. A fungal infection in the mouth that is characterized by white patches on the cheeks and tongue. These lesions may be painful to the infant.
Children. Symptoms seen in children older than 1 year of age can be divided into three different categories, from mild to severe. They may include the above symptoms, but may also include the following:
Swollen lymph nodes
Pneumonitis--swelling and inflammation of lung tissue
Two serious bacterial infections in a two-year period (meningitis, blood infection, or pneumonia)
Swelling of the parotid gland (salivary glands located in front of the ear)
Oral thrush that lasts for more than two months
A yeast infection that occurs in the digestive track or lungs
Constant or recurring sinus infections
Constant or recurring diarrhea
Encephalopathy--an inflammation of the brain
Constant or recurring ear infections
A fever that persists for more than one month
Tumors or malignant lesions
Dermatitis--an itchy, rash on the skin
Hepatitis--an inflammation of the liver that is often caused by an infection
Pneumocystis carinii pneumonia (the type of pneumonia most commonly seen with HIV)
Abdominal swelling from increased liver and spleen size
Adolescents. Symptoms of HIV in teens may be the same as in children, and may also be more similar to the symptoms commonly seen in adults with HIV. Some teens and adults may develop a flu-like illness within a month or two after exposure to the HIV virus, although, many people do not develop any symptoms at all when they first become infected. In addition, the symptoms that do appear, which usually disappear within a week to a month, are often mistaken for those of another viral infection. Symptoms may include:
Persistent or severe symptoms may not surface for 10 years or more, after HIV infection first enters the body in teens and adults. This "asymptomatic" period of the infection is highly variable from person to person. But, during the asymptomatic period, HIV is actively infecting and killing cells of the immune system. Its most obvious effect is a decline in the blood levels of CD4+ cells (also called T4 cells)--the immune system's key infection fighters. The virus initially disables or destroys these cells without causing symptoms.
An HIV-infected child is usually diagnosed with AIDS when the immune system becomes severely damaged or other types of infections occur. As the immune system deteriorates, complications begin to develop. The following are some common complications, or symptoms, of the onset of AIDS. However, each child may experience symptoms differently. Symptoms may include:
Lymph nodes that remain enlarged for more than three months
Lack of energy
Frequent fevers and sweats
Persistent or frequent yeast infections (oral or vaginal)
Persistent skin rashes or flaky skin
Pelvic inflammatory disease that does not respond to treatment
Short-term memory loss
Severe or unusual infections (opportunistic infections)
Some people develop frequent and severe herpes infections that cause mouth, genital, or anal sores, or a reactivation of chickenpox known as shingles.
The symptoms of an HIV infection may resemble other medical conditions. Always consult your child's doctor for a diagnosis.
How is HIV diagnosed?
Diagnosis of HIV infection during infancy depends on the detection of the virus. Since all infants born to HIV-infected mothers have a positive antibody test at birth because of the passive transfer of the HIV antibody across the placenta, virological testing is used to confirm the diagnosis.
For infants born to HIV-infected mothers, viral diagnostic testing is usually performed within the first 2 days of life, at 1 to 2 months of age, and at 4 to 6 months of age. A diagnosis of HIV infection can be made with two positive virologic tests obtained from different blood samples.
For children over 18 months, adolescents, or adults, diagnosis is made by testing the blood for the presence of HIV antibody.
Is it safe for children with HIV to receive routine immunizations?
MMR, or measles, mumps, and rubella vaccine, is safe to give to children with HIV, unless they have a severely weakened immune system.
DTaP/Td vaccine (diphtheria, tetanus, and pertussis) is safe to give to infants and children with HIV.
Hib (Haemophilus influenzae type b) and Hep B (hepatitis B) vaccines are safe to give to children with HIV.
Hepatitis A and B vaccines are safe to give to HIV-positive children.
VZIG (varicella vaccine) should be considered for known HIV-positive children, depending on their immune status.
A yearly influenza vaccine (or "flu shot") is recommended for children with HIV, as well as any individual living in the same household as a child with HIV. There are two types of influenza vaccine; children and adults with HIV should receive the "shot" form of the vaccine--not the nasal spray form, as it contains a live virus. Pneumococcal vaccine can be safely administered to age-appropriate HIV-infected children.
Always consult with your child's doctor regarding immunizations for an HIV-infected child.
What is the treatment for HIV?
As with many other conditions, early detection offers more options for treatment. Today, there are medical treatments that can slow down the rate at which HIV weakens the immune system, but, currently, there is no cure for the disease. However, there are other treatments that can prevent or cure the conditions associated with HIV. Anti-retroviral drug therapy may be given to a pregnant woman, which has proven to greatly reduce the chance of an infant developing HIV. A cesarean section may be recommended to reduce infant transmission from the birth canal. In the U.S., where other feeding options are available, an infected mother should be discouraged from breastfeeding her infant. Consult your child's doctor for more information regarding various drug therapies.