HIV in Children: Causes, Symptoms, and Management

Does HIV Infect Children?

Yes, children can be affected by HIV. The Centers for Disease Control and Prevention (CDC) reported that in 2021, 53 children under the age of 13 were diagnosed with HIV in the United States and six dependent areas. This number is less than half compared to 2017, when 105 cases were recorded in the same age group.

How Do Children Get HIV?

In children under 13 years of age, all HIV infections come from vertical transmission. Vertical transmission means the infection is passed from a mother to her child during pregnancy, childbirth, or breastfeeding. Not every child born to an HIV-positive mother gets the virus.

Doctors often recommend cesarean delivery for mothers with HIV because the virus can pass to the baby more easily during vaginal birth.

Transmission of HIV in Children:

• HIV can be passed to children from their mothers before birth, during delivery, or through breastfeeding.

• Most HIV cases in infants come from an HIV-positive couple having a baby. In the United States, over 95 percent of infants with HIV got it from their mothers either before or after birth.

• In adults and teenagers, HIV spreads mainly through sexual contact with an infected individual. The virus can pass through the lining of the vagina, penis, vulva, rectum, or mouth if the lining is damaged. Children can also get HIV if they are sexually abused by an infected person.

• HIV can spread through blood. In the past, children with hemophilia (a condition that makes blood clot slowly) received contaminated blood products, which could give them HIV. Today, blood is carefully screened, so this risk is very low.

• Sharing needles or syringes with individuals infected with HIV can also spread the virus.

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

Symptoms of HIV in Children:

HIV symptoms vary depending on the child’s age.

1. Infants:

HIV is hard to detect in babies under one year, so doctors need to test them multiple times. Symptoms include:

• Poor weight gain and slower bone growth.

• A swollen abdomen (belly) due to an enlarged liver and spleen.

• Occasional diarrhea.

• Pneumonia (infection and swelling in the lungs).

• White patches in the mouth called oral thrush (a fungal infection that can hurt the baby’s mouth and tongue).

2. Children:

Symptoms in children over one year old can be mild, moderate, or severe.

• Mild: Enlarged lymph nodes and parotid glands near the jaw, repeated sinus or ear infections, itchy skin rashes, and abdominal swelling caused by an enlarged liver and spleen.

• Moderate: Inflammation of the lungs (pneumonitis), ongoing or recurrent diarrhea, fever that lasts for a long time, oral thrush persisting for more than two months, severe chickenpox, liver inflammation (hepatitis), and problems affecting the kidneys.

• Severe: Serious bacterial infections like meningitis (infection around the brain), pneumonia, and blood infections. Fungal infections can develop in the lungs or digestive system. The child may have encephalopathy (brain damage) or tumors (abnormal growths). Pneumocystis jirovecii pneumonia (a severe lung infection common in HIV) may also appear.

3. Adolescents:

Symptoms are similar to adults. Some teenagers get flu-like illnesses within a month of infection. They may have a fever, headache, general feeling of sickness, and swollen lymph nodes.

These symptoms often go away, but ten years or more later, severe problems can start. During this time, HIV damages the immune system silently, especially T4 cells (white blood cells important for fighting infections).

Children are diagnosed with AIDS when their immune system becomes very weak or other diseases appear. They may have:

• Swollen lymph nodes for more than three months.

• Fatigue, weight loss, recurring fever, and night sweats.

• Frequent yeast infections, persistent skin rashes, and pelvic infections that do not get better.

• Short-term memory problems and high susceptibility to opportunistic infections (illnesses that usually do not affect healthy people).

• Severe and long-lasting infections can appear in the anus, vagina, or mouth. Shingles (reactivated chickenpox) can occur. Antiretroviral therapy (ART) has reduced some of these symptoms, but children on treatment may still have higher chances of behavior, learning, or thinking problems.

Diagnosis of HIV Infection in Children

Doctors check for the virus to diagnose HIV. Babies born to HIV-positive mothers often test positive for HIV antibodies at birth because the mother’s antibodies cross the placenta. Therefore, special virological tests are used to confirm HIV in infants.

Virological testing (like polymerase chain reaction tests, or PCR) is done at:

• The first two days after birth.

• One to two months old.

• Four to six months old.

Two positive test results from separate blood samples confirm HIV infection.

For children older than 18 months and adolescents, HIV is diagnosed using blood tests that detect HIV antibodies.

Treatment of HIV Infection in Children

Managing HIV in children involves antiretroviral therapy (ART), routine follow-up visits, and close medical monitoring.

1. Antiretroviral Therapy (ART):

ART is the primary treatment for HIV. Medicines are started as soon as the diagnosis is confirmed. The drugs used are similar to those given to adults, but the doses and combinations are adjusted to suit children.

2. Monitoring:

Doctors check viral load (amount of virus in the blood) and CD4 count (a type of white blood cell). A high viral load may show that the virus is resisting medication or that the child is not taking medicine correctly. Doctors may change the medicine if needed. Viral load and CD4 tests are usually done every three to four months. Blood and urine tests are done twice a year.

3. Following the Treatment Schedule:

The most important care for children and adolescents with HIV is making them take HIV medicines exactly as prescribed. Missing doses can make HIV resistant to treatment. Children may find it hard to take complex medicine schedules. Doctors often use combination pills (more than one medication in a single pill) to make it easier, usually taken once or twice a day.

Prevention of HIV Infection in Children

Pregnant women with HIV can take medicines to prevent passing the virus to their babies. HIV-positive mothers should start ART as soon as possible and continue throughout pregnancy and after childbirth.

To reduce the risk during breastfeeding, mothers can use formula milk or donor milk instead of breastfeeding.

Conclusion

Many children get HIV from their mothers before birth or during breastfeeding. Maternal ART has reduced the chances of HIV infection in recent years. Children born with HIV receive ART, often for a long period. New HIV cases in children are low, but infections in adolescents have increased.

If you know an HIV-infected pregnant woman or a child who has HIV, do not wait; consult our HIV specialist for the right guidance and support for the well-being of the child as well as of the mother.

Key Takeaways

• Most children who have HIV get it from their mother during pregnancy, at birth, or while breastfeeding, though many children who are exposed never become infected.

• In children and teenagers, the symptoms often start off mild, such as getting sick often or growing more slowly than expected, and these signs may not appear for several years.

• Early diagnosis and consistent anti-retroviral therapy (ART) help children and teens live healthier lives and reduce the risk of severe complications.