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Paediatrics: Human immunodeficiency virus

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

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.

 

 

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