Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
PEDIATRIC HUMAN IMMUNODEFICIENCY VIRUS INFECTION
Infect Dis Ther; 3:153-70 1989. Unique Identifier : AIDSLINE ICDB/90665444 Weintrub PS; Scott GB; Dept. of Pediatric Infectious Diseases and Immunology, Univ. of; California, San Francisco, CA
Abstract:
Children can acquire HIV infection by several routes: (1) perinatally, from an infected mother; (2) from blood or blood products, including nonheat-treated factor VIII or IX concentrates; (3) sexual abuse or teenage sexual activity; and (4) iv drug use. At present, almost all pediatric HIV infections are perinatally transmitted, representing approx 80% of the cases nationally. Maternal infection is the most common source of infection in children, yet the risk and the exact route of transmission are not known. Estimates of the incidence of infection in infants of seropositive women range from 35% to 70%. Children with HIV infection from maternal-to-infant transmission have symptoms within the first few months of life, although transfusion and sexually transmitted cases often have incubation periods of several years. Most children with HIV infection die within 2 yr. Common clinical manifestations of pediatric HIV infection include recurrent bacterial infections (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, enteric gram-negative rods), acute pneumonitis (Pneumocystis carinii pneumonia), chronic pneumonitis (lymphoid interstitial pneumonitis, pulmonary lymphoid hyperplasia, desquamative interstitial pneumonitis), oral thrush, diarrhea, lymphadenopathy, hepatosplenomegaly, failure to thrive, developmental delay, encephalopathy, and parotitis. Malignancies are reported in children, although not as commonly as in adults. Kaposi's sarcoma and lymphomas are seen rarely in children. Laboratory investigations of children with HIV infection have shown a variety of defects, which differ to some extent from those seen in older patients. A number of factors complicate the diagnosis of HIV infection in children, particularly those cases resulting from vertical transmission. First, symptomatic HIV infection must be distinguished from the various congenital immunodeficiencies. An additional diagnostic difficulty stems from the transport of maternal IgG across the placenta. Acute infections, routine or opportunistic, need prompt diagnosis and aggressive treatment. The management issues requiring special attention in the newborn period are breast-feeding, circumcision, and blood transfusions. No licensed antiviral treatment for children with AIDS exists at present. A small number of infants have been treated with ribavirin without improvement. Zidovudine (AZT) is not approved for children under 13 yr of age, but clinical studies of AZT in children currently are under way. (39 Refs)
Keywords: Acquired Immunodeficiency Syndrome/COMPLICATIONS/*DIAGNOSIS/ THERAPY/TRANSMISSION AIDS Dementia Complex/DIAGNOSIS Child Child, Preschool Diagnosis, Differential Female Human HIV Infections/COMPLICATIONS/*DIAGNOSIS/THERAPY/TRANSMISSION Infant Infant, Newborn Male Opportunistic Infections/COMPLICATIONS/DIAGNOSIS Pregnancy Pregnancy Complications, Infectious/DIAGNOSIS Risk Factors JOURNAL ARTICLE REVIEW, TUTORIAL REVIEW 901030
M90A0691
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
