Human immunodeficiency virus HIV

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retrovirus that causes acquired immune deficiency syndrome (AIDS) via transmission through contact with infected person's blood, semen, cervical secretions, or cerebrospinal fluid. AIDS is a condition in which an acquired immune deficiency, which lowers the body's resistance to disease, results in infections, some forms of cancer, and the degeneration of the nervous system.

It is possible to be infected with HIV and not have AIDS; some children are infected for years before they get sick. HIV infection leading to AIDS has been a major cause of illness and death among children.

Nationally, HIV infection leading to AIDS was the seventh leading cause of death in 1992 among children one to four years of age. By 1995 the Centers for Disease Control and Prevention (CDC) had received reports of about 5,500 children who had acquired HIV infection at birth.

During the 1990s nearly 90 percent of existing AIDS cases reported among children and virtually all new HIV infections among children in the United States could be attributed to transmission of the HIV virus at birth. An increasing proportion of AIDS cases were reported in children whose moth ers were infected with HIV before the child was conceived through heterosexual contact with an infected partner whose infection status and risk factors were not known by the mother.

Cause

Infants Nearly all HIV infections in U.S. children under age 13 are from infection while in the mother's womb or while passing through the birth canal, although not every child born to an infected mother will have the virus. Between 6,000 and 7,000 children are born to HIV-infected mothers each year in the United States.

Between 1992 and 1997 the number of infants who became HIV positive when born to an infected mother plummeted by 50 percent as a result of new antiretroviral medications now given to the mother during delivery.

Because transmission often occurs during delivery, cesarean section may be indicated for some women. The virus also has been detected in breast milk, so infected mothers should not breast-feed.

Children Before 1985 a small group of children were infected with the virus by contaminated blood products. Since then, blood products have been screened for the virus and risk of infection from this route has been virtually eliminated.

Teens In adolescents HIV is most commonly spread by sexual contact with an infected partner. The virus enters the body through the lining of the vagina, vulva, penis, rectum, or mouth through sexual activity. Teens between the ages of 13 and 19 represent one of the fastest growing HIV-positive groups. HIV is also spread by sharing needles, syringes, or drug use equipment with someone who is infected with the virus.

In general, HIV infection is not very contagious from one child to another. Across the country there have been only a few reported transmissions, all of which involved direct blood contact in a family setting. Despite widespread concerns, there are no reported transmissions of the HIV virus within a school or child-care setting.

Since the largest danger is direct blood contact, those in schools and child-care programs should routinely use gloves when in contact with blood. As children with HIV become older and the latency period stretches longer, counseling and education are imperative to prevent sexual transmission of the virus.

Diagnosis

Early HIV infection often causes no symptoms and must be detected by testing a child's blood for the presence of disease-fighting proteins called antibodies. HIV antibodies usually do not reach levels high enough to detect by standard blood tests until one to six weeks after infection, and it may take as long as six months. Children exposed to HIV should be tested for HIV infection as soon as they are likely to develop antibodies to the virus. When a child is highly likely to be infected with HIV and yet antibody tests are negative, a test for the presence of HIV itself in the blood is used. Repeat antibody testing at a later date, when antibodies to HIV are more likely to have developed, is often recommended.

When a new baby is born to an HIV-infected mother, however, an antibody test is almost guaranteed to be positive, since babies have their HIV-infected mother's antibodies for up to 18 months after birth. Uninfected infants will gradually lose their mother's antibodies during this time, whereas infected infants generally remain antibody positive. Instead, a diagnosis can be made in early infancy by using a viral culture (PCR—polymerase chain reaction), or a p24 antigen test.

According to the U.S. Public Health Service, HIV-infected women should be encouraged to obtain HIV testing for any of their children born after they became infected or, if they do not know when they became infected, for children born after 1977. Children over age 12 should be tested with proper consent. Women should be informed that the lack of signs and symptoms suggestive of HIV infection in older children may not mean that the child is not infected.

Symptoms

Although there are no immediate physical signs of HIV infection at birth, children born with HIV can develop the opportunistic infection Pneumocystis carinii pneumonia (PCP) in the first months of life. Opportunistic infections like PCP take advantage of an HIV-infected child's weakened immune system. In the past 10 percent to 20 percent of children infected at birth rapidly developed this progressive disease and died by two years of age. However, in more recent years all babies born to mothers with HIV or AIDS are suspected of having the virus and are routinely treated, so as a result, fatalities have been greatly reduced.

other possible symptoms of babies born with HIV infection include low birth weight. Within two to three months, the infected child also may experience poor weight gain, thrush, enlarged lymph nodes, enlarged liver and/or spleen, neurological problems, bacterial infections, and pneumonia.

In children with HIV, the following opportunistic conditions can frequently occur:

• Pneumocystis carinii pneumonia (PCP)—pneumo-nia caused by a microorganism that cannot be fought off due to a weakened immune system

• lymphoid interstitial pneumonia (LIP)—walking pneumonia that becomes chronic and is sometimes characterized by coughing and shortness of breath

• bacterial, viral, and yeast infections

• meningitis

• fungal infections

• esophagitis—inflammation of the esophagus

• parasitic infections

Unlike adult cases, malignancies are rare in children with HIV. The two most difficult conditions among children infected with HIV or who have AIDS are wasting syndrome (the inability to maintain body weight due to lack of appetite), and HIV encephalopathy or AIDS dementia (infection of the brain that can cause brain swelling or atrophy). Wasting syndrome can sometimes be helped with nutritional counseling, while encephalopathy remains extremely difficult to treat.

Treatment

There is no known cure for AIDS. While current treatment advances can slow the progression of the disease and improve quality of life, life expectancy is still reduced significantly. Although all children with HIV will eventually become sick, recent advances in treatment have prolonged the onset of this inevitability.

A major factor in reducing the number of deaths from HIV and AIDS in this country has been highly active antiretroviral therapy (HAART). HAART is a

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