Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
PEDIATRIC ONCOLOGY: THE ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)
Principles and Practice of Pediatric Oncology. Pizzo PA, Poplack DG, eds. Philadelphia, Lippincott, p. 783-96, 1989.. Unique Identifier : AIDSLINE ICDB/89655616 Pizzo PA; Eddy J; Falloon J; Pediatrics/Infectious Diseases, NCI, Bethesda, MD
Abstract:
Although just over 1000 cases of pediatric AIDS were reported to the Centers for Disease Control as of June 1988, it is projected that this number will exceed 3000 by 1991, with some estimates projecting upward of 10,000 cases of children infected with the AIDS-associated human immunodeficiency virus (HIV). Many of the basic biological insights gained from this retrovirus disorder may have therapeutic implications for cancer, and many of the treatment concepts used in cancer are applicable or relevant to the design of therapeutic strategies for pediatric AIDS. AIDS thus stands at the interface between immunology, infectious disease, and oncology. AIDS is reviewed in the present chapter under the following headings: definition of AIDS in children, epidemiology (transplacental and perinatal transmission, blood product transmission), genetics, biology (virology, immunology), pathology, clinical manifestations (infectious complications, noninfectious complications), methods of diagnosis, prognostic considerations and variables, treatment and management considerations (general supportive care, antiretroviral therapy, immunologic reconstitution), and future considerations. The subsection on noninfectious complications in relation to clinical manifestations covers encephalopathy, pulmonary disease, cardiac abnormalities, immunohematologic abnormalities, less common abnormalities, and malignancies associated with HIV infection in children. The subsection on general supportive care in treatment and management considerations includes hospital care and care at home, in the community, and in school. The subsection on immunologic reconstitution in treatment and management considerations covers interferon and interleukin, immunoglobulins, and other measures. Future issues involve three basic areas: earlier diagnosis, better therapy, and prevention by vaccination. Early diagnosis will allow treatment to begin before significant immunologic impairment has occurred. Better therapy can be achieved by development of improved and specific antiretroviral agents that will most likely be used in combination, perhaps with adjunct immunomodulators. The heterogeneity of the envelope region of HIV is just one of the problems that must be overcome with vaccine development. Whereas the goal of stopping transmission of HIV may be met in the future by an effective vaccine, the present challenge is to limit the spread of HIV infection. (184 Refs)
Keywords: Acquired Immunodeficiency Syndrome/COMPLICATIONS/*THERAPY/ TRANSMISSION Antiviral Agents/THERAPEUTIC USE AIDS-Related Complex/THERAPY Child Combined Modality Therapy Human HIV/DRUG EFFECTS Palliative Care Risk Factors MONOGRAPH REVIEW REVIEW, TUTORIAL
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Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
