Abstract:
As of February 1989, slightly more than 1400 cases of AIDS in children have been reported to the Centers for Disease Control (CDC), reflecting less than 2% of total cases reported to date. However, authorities project as many as 20,000 children with AIDS will be described during the next several years. CDC criteria (the September 1987 revision is summarized in a table) still miss approx 25% of children with AIDS. The anticipated increase in HIV disease in children is largely related to spread of this infection among women of childbearing age who share needles with iv drug abusers or have sex with an infected partner. An unresolved question in this vertical transmission is whether perinatal infection is acquired during gestation or intrapartum. The majority of women who give birth to a child diagnosed with AIDS are themselves asymptomatic for HIV infection during pregnancy and at delivery. Not every offspring of a seropositive HIV-infected mother will be infected. Another complicating factor of pediatric AIDS is the difficulty in diagnosing the infection in a child less than 15 mo of age. Among the major manifestations of HIV infection in the pediatric age group are recurrent bacterial infections, particularly with encapsulated organisms. Perhaps the most devastating manifestations of HIV infection in children are the neurodevelopmental deficits that appear to occur in virtually all infected children. In an early study of antiretroviral strategies for children, four dose levels of AZT (0.5, 0.9, 1.4, and 1.8 mg/kg/hr) were administered by continuous iv infusion to 21 children with AIDS or ARC, but free of opportunistic infections and not receiving other medications, including immunoglobulins. Of these 21 children, 13 (62%) had evidence of neurodevelopmental abnormalities prior to therapy; all improved after beginning the continuous-infusion AZT regimen. Significant improvement in IQ scores (mean increment, 15.3 +/- 3.3 IQ points) was corroborated with improved clinical status and CT and PET scans. An unexpected finding from serial psychometric testing of all 21 children was significant improvement in IQ scores of those whose pretreatment status was in the 'normal' IQ range, strongly suggesting that subclinical cognitive impairment may be an early manifestation of HIV disease in infected children. Tables summarize a classification system for HIV-infected children less than 13 yr of age, evidence to determine when perinatal transmission of HIV occurs, clinical features that differ between children and adults with HIV infection, nonbacterial infections in HIV-infected children, organ involvement in children with HIV infection, and treatment of infectious complications. Additional studies of antiretroviral therapy are reviewed, and treatment of infectious (bacterial, opportunistic, fungal, viral) complications is summarized. (19 Refs)
Keywords: Antiviral Agents/*THERAPEUTIC USE Child Clinical Trials Dose-Response Relationship, Drug Human HIV/*DRUG EFFECTS HIV Infections/*DRUG THERAPY Infusions, Intravenous Opportunistic Infections/DRUG THERAPY Zidovudine/*THERAPEUTIC USE CLINICAL TRIAL JOURNAL ARTICLE 900430
M9040668
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