Human immunodeficiency virus
HIV infection in children is a global issue caused mainly by the retrovirus HIV (human immunodeficiency virus) type 1.
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
• Use of antenatal, perinatal, and postnatal antiretroviral drugs.
• Avoid labour and birth canal contact by elective Caesarean section.
• Avoidance of breastfeeding.
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.
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.
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.
• Prophylaxis against PCP.
• Avoidance of live oral polio vaccine and BCG.
• Antiretroviral therapy to suppress viral replication.
Social, psychological, and family support.