HIV INFECTION IN

PEDIATRIC
Introduction
Most HIV-infected children are born in developing
countries.

HIV infection in children progresses more rapidly than

in adults, and some untreated children die within the
1st 2 yr of life.

This rapid progression is correlated with higher viral

burden and faster depletion of infected CD4
lymphocytes in infants and children than in adults.

Nelson Pediatic 18th edition

Etiology
HIV-1 and HIV-2 are members of the Retroviridae
family
Epidemiology
The World Health Organization (WHO) estimated that
>39 million persons worldwide were living with HIV
infection at the end of 2004 including 2.2 million
children <15 yr of age.

In 2004, almost 5 million people acquired HIV and 3

million died, including 510,000 children.

More than 90% of HIV-infected individuals live in

developing nations
 Transmission
Vertical transmission of HIV can occur:
before (intrauterine),
during (intrapartum),
or after delivery (through breast-feeding)
Transfusions of infected blood or blood products have accounted
for 36% of all pediatric AIDS cases

Several risk factors influence the rate of vertical

transmission:
preterm delivery (<34 wk gestation),
a low maternal antenatal CD4 count,
and use of illicit drugs during pregnancy
Clinical Manifestasion
Category A (mild symptoms)
includes children with at least 2 mild symptoms such as
lymphadenopathy, parotitis, hepatomegaly, splenomegaly, dermatitis,
and recurrent or persistent sinusitis or otitis media

Category B (moderate symptoms)

includes, for example, children with LIP, oropharyngeal thrush
persisting for >2 mo, recurrent or chronic diarrhea, persistent
fever for >1 mo, hepatitis, recurrent herpes simplex virus
(HSV) stomatitis or HSV esophagitis or pneumonitis,
disseminated varicella (i.e., with visceral involvement),
cardiomegaly, or nephropathy

 Category C (severe symptoms)
includes, for example, children with 2 serious bacterial infections
(sepsis, meningitis, pneumonia) in a 2 yr period,
esophageal or lower respiratory tract candidiasis, cryptococcosis,
cryptosporidiosis (>1 mo),
encephalopathy,
malignancies,
disseminated mycobacterial infection,
Pneumocystis pneumonia,
cerebral toxoplasmosis (onset >1 mo of age),
and severe weight loss.
Diagnosis
 Viral diagnostic testing should be performed within the 1st 48 hr of life

Infants born to HIV-infected mothers should be prescribed zidovudine (ZDV)

prophylaxis.

A complete blood count, differential leukocyte count, and platelet count

should be performed at 4 wk of age to monitor ZDV toxicity.

If the child is found to be HIV-infected or if the HIV status is not clear, these
tests should be continued every 13 mo to assess the hematologic effect of
the disease or its treatment (prophylactic TMP-SMZ and anti-retroviral
therapy).

If the child is found to be HIV infected, CD4 and CD8 lymphocyte counts
should be performed at 1 and 3 mo of age and repeated every 3 mo.

The frequency of the test should be increased (every 46 wk) if the CD4
lymphocyte count or percentage declines rapidly.
Treatment
nucleoside (or nucleotide) reverse transcriptase inhibitors
(NRTIs). The NRTIs have a similar structure to the building
blocks of DNA (e.g., thymidine, cytosine).

NNRTIs (non-nucleoside reverse transcriptase inhibitors)

(nevirapine, efavirenz) act differently than the NRTIs. They
attach to the reverse transcriptase and restrict its motility,
which reduces the activity of the enzyme.

The protease inhibitors (lopinavir, nelfinavir, saquinavir)

are potent agents that act farther along the viral replicative
cycle.
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