Paediatrics: Human immunodeficiency virus

Human immunodeficiency virus

HIV infection in children is a global issue caused mainly by the retrovirus HIV (human immunodeficiency virus) type 1.

Vertical transmission of HIV

Children at risk of acquiring the virus are infants of HIV-positive mothers, although it is now rare because of the success of ante-natal preventative measures.

•   Infants may become infected during labour and the postnatal period.

•   Rate of vertical transmission is 20–40% without suitable management but <1% with effective prophylaxis

Prevention of vertical transmission

•   Use of antenatal, perinatal, and postnatal antiretroviral drugs.

•   Avoid labour and birth canal contact by elective Caesarean section.

•   Avoidance of breastfeeding.

Clinical features

Dormant infection lasts a short period and has few or no clinical features.

The later features of paediatric HIV infection are the following.

•   Gastrointestinal: chronic diarrhoea, failure to thrive.

•   CNS: delayed development and cerebral palsy

•   Recurrent bacterial and viral infection.

•   Lymphadenopathy and hepatosplenomegaly.

•   Opportunistic infections: Pneumocystis carinii, Candida, herpes virus, Varicella, and atypical mycobacteria.

•   Respiratory distress: cough, hypoxaemia, bilateral nodular infiltrates on CXR.

Acquired immune deficiency syndrome (AIDS)

Lymphocytic interstitial pneumonitis, Pneumocystis carinii (PCP) infection, and Candida oesophagitis are ‘AIDS defi ning’ in an HIV-positive child; they signify progression to the AIDS phase.

Diagnosis

The diagnosis of HIV infection depends on demonstrating the following:

•   Specific antibody response (anti-HIV antibodies): infants infected perinatally have an immune response by 4–6mths of age. However, an uninfected infant of a HIV-positive mother can test positive for anti-HIV antibodies for up to 12–18mths.

•   Virus or its components in the blood (PCR): high specificity tests.

Treatment

•   Prophylaxis against PCP.

•   Avoidance of live oral polio vaccine and BCG.

•   Antiretroviral therapy to suppress viral replication.

Social, psychological, and family support.