AIDS in Pediatrics: Recent Perspective

What Is AIDS?

Acquired immunodeficiency syndrome (AIDS) is caused by HIV (human immunodeficiency virus). Retrovirus HIV-1 is a common cause of infection compared to retrovirus HIV-2. The virus weakens the immune system, making the body increasingly less able to fight against illness or infections. All HIV infections in children below 13 years result from vertical transmission. It means the infection is passed from the mother to the unborn child during pregnancy, delivery, or breastfeeding.

Before 1985, blood products were unscreened, and the risk for HIV transmission to children through blood infusion was high. Post 1985, routine screening of blood products reduced HIV diagnosis in children.

Not all children born to HIV-infected mothers acquired the disease. It results from increased HIV testing and the administration of new anti-retroviral drugs to expectant moms. HIV-infected moms are recommended for cesarean sections since there is an increased risk of HIV transmission during childbirth.

How Does HIV Spread?

HIV can spread through the following modes:

• Vertical Transmission: The infection can spread from being born or breastfed by HIV-infected mothers.

• Sexual Contact: In adults or adolescents, the virus can spread from sexual contact with an infected partner. The HIV infection can penetrate the lining of the vagina, penis, vulva, and rectum, disrupting the lining of the oral cavity during sexual activity. Child sexual abuse by an infected person can result in HIV infection.

• Contaminated Blood: The infection can spread when an individual comes in contact with infected blood. Earlier, children with hemophilia or coagulation disorder received contaminated blood products. Given that donor blood is screened, there is little chance of contracting HIV through blood transfusions.

• Needles: The infection can spread by sharing injections, needles, and drug abuse with an infected person.

HIV infection does not spread through saliva, tears, sweat, sharing personal items, swimming pools, toilet seats, or insect bites.

What Are the Symptoms of HIV in Pediatrics?

Infants, children, and adolescents exhibit different symptoms. The symptoms include:

1. Infants: HIV infection is hard to diagnose in infants below one year and requires repeated testing.

• Because their physical and developmental growth is impeded, the infant does not thrive.

• The infant exhibits poor weight gain and bone growth.

• The abdomen appears swollen because of an enlarged liver and spleen.

• The child may experience intermittent diarrhea.

• Pneumonia (inflammation in lungs).

• White patches of fungal infection known as oral thrush can develop in the cheeks and tongue. These are painful to the infants.

2. Children: Symptoms in children older than one year can be mild, moderate, and severe.

• Mild: The lymph nodes and parotid glands are swollen. There are constant and recurring sinus or ear infections. An itchy rash develops on the skin. The abdomen swells due to an enlarged liver and spleen.

• Moderate: The child may develop pneumonitis and recurring diarrhea. Fever can linger for over a month, and oral thrush may last for over two months. The child may also develop complicated chicken pox, hepatitis (liver inflammation), and kidney disease.

• Severe: The child can develop severe bacterial infections like meningitis (inflammation in brain meninges), pneumonia, and blood infection within two years. Fungal infections develop in the child’s lung or digestive tract. The child develops encephalopathy and benign or malignant tumors. Pneumocystis jirovecii pneumonia, commonly associated with HIV, develops in severe infections.

3. Adolescents: The symptoms resemble those of adults or children. Few adolescents develop flu-like illness within a month of HIV exposure. The symptoms that develop are fever, headache, malaise (feeling of sickness), and enlarged lymph nodes. After a while, the symptoms go away, and after ten years or more, the severe symptoms start to show. Each person's asymptomatic phase is different, and during this time, HIV is aggressively infecting and killing immune cells. The most significant presentation is a decline in blood levels of T4 cells. The cells are initially disabled or destroyed without inducing symptoms.

Children with HIV infection get diagnosed with AIDS when their immune system weakens completely or other diseases are acquired. With a deteriorating immune system, complications develop. The lymph node swelling persists for more than three months. Children show signs of fatigue, loss of weight, recurrent fever, and sweating. The children have frequent yeast infections, persistent skin rashes or flaky skin, and pelvic inflammatory disease unresponsive to treatment. Some exhibit short-term memory loss and are susceptible to opportunistic infections.

Children display severe and enduring anus, vaginal, and oral infections. There can be reactivation of chickenpox, known as shingles. Anti-retroviral therapy has reduced the manifestation of some symptoms, but treated children have a higher risk for developing behavioral, developmental, and cognitive problems.

How Is HIV Diagnosed in Children?

The presence of the virus determines HIV in children. Since antibodies are positively transferred across the placenta, most children born to HIV-positive mothers have positive antibody testing at birth. Therefore, virological testing can confirm disease diagnosis in infants.

Virological testing (polymerase chain reaction tests) for infants is carried out within the first two days of birth, one to two months of age, and four to six months of age. When two positive test results are acquired from various blood samples, HIV infection is considered confirmed.

Blood tests for HIV antibodies are used to diagnose the condition in adolescents and children older than 18 months.

Can HIV-Positive Children Receive Immunizations?

• Children can receive the MMR vaccine (measles, mumps, and rubella) without risk unless they have a compromised immune system.

• Vaccines for diphtheria, tetanus, and pertussis are safe.

• Hepatitis B and Hemophilus influenza type B vaccines are safe.

• Varicella immune globulin is administered to children with known infection or immune status.

• HIV-infected children and those living with them must receive yearly flu shots. Since nasal sprays contain live viruses, they are not advised.

• Pneumococcal vaccines are safe.

How Is HIV Treated in Children?

Early diagnosis helps control the infection better. Specialists offer medical care that reduces the rate of infection, which impairs the immune system. Other therapies, such as an anti-retroviral medication for expectant mothers, halt the spread of illness to infants. Cesarean section to stop birth canal infection transmission. HIV-infected mothers are discouraged from breastfeeding and advised on alternative feeding methods.

Conclusion

Most children and adolescents with HIV acquire the infection from the mother before birth, during, and breastfeeding. Maternal antiretroviral therapy has reduced the HIV infection rate in recent years. Children born with HIV are treated with anti-retroviral therapy for a short period. The diagnosis of new infection cases is low among children but has increased in adolescents.