in response to HIV infection. Unless the truly HIV-infected infants can be identified within the first few weeks of life, all infants born to infected mothers will be given Pneumocystis carinii pneumonia (PCP) prophylaxis to prevent this life-threatening infection in the 25 percent of them who are truly HIV-infected. To reduce this problem the Centers for Disease Control and Prevention recommends first identifying pregnant women who are HIV-infected and then screening their newborns by using new tests that identify the presence of the virus itself, rather than antibodies to it, in blood. These new tests can accurately identify 90 percent of truly HIV-infected infants within the first month or two of life.

Note that HIV-infected children are subject to most of the opportunistic infections that can occur in adults. Some that are particularly notable in HIV-infected children are bacterial infections, can-didiasis and other fungal infections (oral candidia-sis, esophageal candidiasis, other fungal infections such as ringworm and athlete's foot), herpesvirus infections, measles virus, Mycobacterium avium complex, Pneumocystis carinii pneumonia, and tuberculosis. Diarrhea, lymphoid interstitial pneumonitis, and HIV encephalopathy are other important conditions in children with HIV disease.

Since the beginning of the AIDS pandemic, the treatment of infants and children with HIV infection has presented unique problems. Even before the introduction of antiretroviral drug therapy when the standard of care for patients was palliative, the management of HIV infection in infants and children was especially difficult. Many of the drug treatments and therapies used to delay or treat opportunistic infections in adults were not readily applicable to the care of pediatric patients. Moreover, whereas the appropriate dosages for most drug treatments are well established for adults, the dosages that are safe and effective for children and infants are not always known. These difficulties continued when antiretroviral agents were introduced in the late 1980s. It was not until the late 1990s that most of the antiretroviral agents used to treat adults became available in pediatric formulations. Thus, the first formal clinical trials of haart in children were begun in 1997, years after the same trials were carried out in adults. The preliminary results show that infants and children with HIV infection can benefit from HAART as adults do. These trials have also raised the question of timing: when should HAART be started in these patients? In adults this same question has long been a source of controversy among HIV clinicians. Some argue that drug therapy should be started as soon as the condition is diagnosed, under the mantra, "hit early, hit hard." The rationale is that the sooner HAART is started, the less the immune system will be damaged and the better off the patient will be in the long run. others strongly disagree. They note that there is no evidence that starting HAART sooner or later has any effect on survival rates. Starting HAART later, when the first symptoms of AIDS appear, might spare patients both the agony of taking pills for years and the toxic effects of drugs, while possibly providing the same benefits of extending survival relatively free of symptoms. These differences in medical opinions apply only to those patients receiving care during the chronic stage of HIV infection. There is far less disagreement among physicians regarding when to initiate HAART among newly infected individuals in the acute stage of the disease— immediately. It has now been theorized that those patients who start a regimen of antiretroviral drugs may be able to reduce critical damage to their immune systems. Moreover, it has also been theorized that in at least a few patients who have been started on HAART at the acute phase immune responses that can suppress HIV without the assistance of drug therapy can later develop. Note that viral suppression without drug therapy is largely unrealistic. The acute stage of HIV infection mimics other, more innocuous infections or gives rise to no symptoms at all. Thus, very few adult patients are diagnosed with acute infection and reach the attention of HIV specialists. over time, few adults are likely to benefit from this strategy.

In pediatric HIV infection, diagnosis during the acute stage is the norm, not the exception. The great majority of infants are infected in utero near term or during the birth process. Thus, most of those infected with the virus have recently acquired it. See breast-feeding; pediatric hiv; pregnancy; transmission.

chimpanzee Because of their genetic similarity to humans, chimpanzees have often been used in HIV and other medical research (chimps are the

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