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Children and HIV
Most children with HIV (anyone age 13 or younger is counted as a child) were born to mothers with HIV or got a transfusion of infected blood. These infections are rare in the developed world. Blood for transfusions is screened. Pregnant women are taking antiviral medications. However, where antiviral medications are not available, or where blood is not routinely screened, children still get infected. Fewer children in the US are infected with HIV each year. In 1992, almost 1,000 children were infected. By 2000, there were just over 100 new infections.
However, the AIDS (acquired immunodeficiency syndrome) epidemic among adolescents in the United States continues to be an
increasing concern. The U.S. Centers for Disease Control and Prevention (CDC) reports that 4,219 cumulative cases of AIDS
among adolescents, or children ages 13 through 19, were reported through June 2001. The number of adolescents living with
HIV (human immunodeficiency virus) is estimated to be much higher.
Because the average period of time from HIV infection to the development of AIDS is 10 years, most young adults with AIDS were likely infected with HIV as adolescents. Most adolescents recently infected with HIV are exposed to the virus through sex.
How do kids get
HIV?
How do teens get HIV?
What Does "HIV
Positive" Mean?
What are HIV and AIDS?
Treatment for
HIV + Children and Teens
Clinical Trials
What is
treatment adherence and why is it important?
For Parents of HIV+
Children
Children can receive HIV from their mothers during or from breastfeeding.
Through June 2001, HIV surveillance data from the CDC suggest that more than one-half of all HIV-infected teen males are infected through sex with men. A small percentage of males appear to be exposed by injection drug use and/or heterosexual contact. The same data suggest that one-half of all adolescent females who are infected with HIV were exposed through heterosexual contact and a very small percentage through injection drug use.
Approximately one quarter of the 15 million cases of sexually transmitted diseases (STDs) reported in the United States each year are among teenagers. This is particularly significant because if either partner is infected with another STD, the risk of HIV transmission increases substantially.
• If one of the partners is infected with an
STD that causes the discharge of pus and mucus, such
as gonorrhea or chlamydial infection, the risk of HIV
transmission is three to five times greater.
• If one of the partners is infected with an STD
that causes ulcers, such as syphilis or genital herpes,
the risk of HIV transmission is nine times greater.
Oral sex is considered a low risk activity. However, you can become infected if you have a break in your skin in or around your mouth. Breaks in the skin can be caused by injuring your gums as you brush or floss your teeth or a tooth that was pulled.
What Does "HIV Positive" Mean?
The term HIV positive is used to describe someone who has become infected with HIV and whose blood has antibodies or markers for HIV, or “positive” for antibodies. These antibodies are made by the immune system. The immune system is the part of your body that fights bacteria and viruses. Antibodies working in the immune system can often protect the body from having a virus or disease again. HIV, however, is very unusual in that it hides in T cells. That means that even though the body makes antibodies to fight HIV, the antibodies cannot find and kill the virus. Therefore, having antibodies for HIV does not protect a person from the disease.
HIV stands for Human Immunodeficiency Virus. It is
the virus that causes AIDS (Acquired Immune Deficiency
Syndrome). AIDS is defined as being HIV positive, and
having clinical manifestations of disease consistent
with AIDS, which can include bacterial “opportunistic”
infections, or neurological, pulmonary, or cardiac complications.
“Opportunistic” infections take advantage
of a person with HIV, because their immune system is
compromised and is unable to fight off infection.
The clinical symptoms of HIV disease in children differ
in important ways from those seen in adults. Children
have less effective immune control of HIV leading to
higher plasma viral loads and perhaps higher tissue
loads. Developing organ systems may be more susceptible
to direct, virally-mediated damage.
Some of the infections or problems that can happen
to children with HIV disease include:
• HIV encephalopathy occurs when HIV crosses into
the brain. The parts of the brain most affected are
those areas involved with a child's moving and speaking.
As a result, children who suffer from encephalopathy
can have problems with stiffness or weakness of the
arms or legs, poor balance and coordination and may
have trouble with crawling or walking. It also may affect
a child's ability to talk or learn new words. Normal
development is slowed and a child may lose skills that
were learned earlier.
• Recurrent bacterial infections include ear infections, blood infections, pneumonias and meningitis, are most common. Children without HIV get these too, but when a child with HIV has these infections again and again, it is a sign that the immune system is damaged.
• Weight loss, not gaining weight, or not growing can happen in children infected with HIV. Children with HIV are often small for their age and may not grow at the same rate as other children. A child may be undersized or underweight because of a specific problem that needs treatment, or because of a loss of appetite related to the HIV and to some of the drug treatments. Gastrointestinal complications are common, such as diarrhea.
Teens infected with HIV can remain healthy for years. However, studies show that certain treatments, including early intervention when you are first infected, can help extend and improve life for a person with HIV.
Treatment for HIV + Children and Teens
Learning that you are HIV positive at a young age is extremely difficult, but there are treatment options available. Most teens with sexually acquired HIV are in a relatively early stage of infection and are ideal candidates for early intervention that may alter the need to be on lifelong antiretroviral therapy.
Children and adolescents who were infected at birth or via blood products as young children follow a unique clinical course that may differ from that of other adolescents and long-term surviving adults. Your pediatrician can decide what treatment options are best suited to your needs.
Recruiting adolescents into clinical trials is important to ensure that research results will be applicable to therapy for that age group. The NYU has clinical trial for both adolescents and children.
What is treatment adherence and why is it important?
Taking a medicine just as your doctor has ordered is called "adherence to treatment." This means taking the right amount of medicine at the right time and in the right way (with food, or on an empty stomach) and without missing or stopping a dose consistently.
Medicines that fight infections cannot work if they are not taken correctly. When a child or teen misses a dose, or if they stop early, HIV can mutate, or change, to survive the medicine. When the medicine no longer works, this is called "resistance."
Treatment adherence can be difficult because everyone forgets to take medicine sometimes. The medicine may also have side effects that make you feel bad.
If your child is having trouble taking a medicine, talk to your doctor, pharmacist or nurse. It may be that medicines can be switched to different ones or on different schedules. Parents of children with HIV can find creative ways to keep their children on schedule, such as using reminders, incentives, beepers, timers, color-coding regimens, and setting up weekly dosing packets to monitor adherence.
My Child And Others
Many parents worry that their child with HIV could infect
others. People do not catch HIV by living in the same
house as an adult or child with HIV infection, going
to playgroup or school, or sharing toys, food and drink
with someone who is infected. Pets and insects cannot
pass on the virus.
HIV is a fragile virus and dies very easily outside the body. However, this is not always the case with other viruses and bacteria. It is therefore important for everyone to use good hygiene, such as washing hands with soap and water, to prevent the spread of other infections, especially to your child.
The only extra care you should take is with blood. Wearing gloves is necessary only when dealing with blood or bloodstained fluids. It is not necessary to wear gloves when bathing a baby or changing diapers.
After cleaning a cut, cover sores and cuts with a bandage for 24 hours, or until a scab has formed. If splashes of blood get on anybody's skin, eyes or mouth, wash the blood off as soon as possible. Soak any bloodstained clothes in cold water first, and then use ordinary laundry soap or detergent in the normal way. Clean up any spilled blood with disposable paper towels or tissues and throw it away in a plastic bag. Use hot soapy water to clean the area, or some diluted bleach (one part bleach to nine parts water) and dispose of the dirty paper or tissues as you normally would.
Since HIV is not transmitted by saliva, dishes and utensils can be washed and dried in the usual way. Babies' bottles should be washed and sterilized in the normal way.
Parents of children with HIV should also be mindful to how difficult it is for kids to take their medicines correctly, when playing with others. Think about problem times and plan ahead. Special instructions may make it hard for you to give your child their medicine. School time, play or daily activities may not fit with their medicine times. Taking medicine in public or in a social situation may cause embarrassment or emotional distress. Going on vacation, trips or camps may make it difficult to stick to their medicine schedule.
Disclosure: Who needs to know about HIV in the family?
Most people are very concerned about whom they should
tell or not tell about HIV in the family. It is your
right to decide this for yourself. The only people who
need to know are the health care staff who work with
you and your child, which may include nurses, physicians,
and social workers, your family doctor and dentist.
Your family doctor and HIV specialist should consult with each other to decide the best treatment for your child. Because infections can start in the mouth, it is also particularly important that all children see a dentist regularly.
Immunizations
There are a few immunization recommendations regarding HIV-infected children that differ from those for HIV-negative children. Encapsulated bacteria cause considerable illness for HIV-infected children, so Haemophilus influenzae (flu) and pneumococcal conjugate vaccines are important. Varicella vaccine is a live virus vaccine but it can be considered safe for HIV-infected children without immuno-suppression. Measles, mumps and rubella vaccine can be safely given to HIV-infected children who do not have severe immunosuppression. Always consult with your pediatrician regarding vaccine administration.