Diseases & Conditions
A disease of the immune system caused by the human immunodeﬁciency virus (HIV) that has been a major cause of illness and death among children and teens worldwide. Nationally, AIDS has been the sixth leading cause of death in the United States among 15- to 24-year-olds since 1991; teens between 13 and 19 represent one of the fastest-growing HIV-positive groups. In recent years AIDS infection rates have been increasing rapidly among teens. Half of all new HIV infections in the United States occur in people under 25 years of age; thousands of teens in the United States become infected each year. According to the Centers for Disease Control (CDC), most new HIV cases in younger people are transmitted through unprotected sex; one-third of these cases are from sharing dirty, blood-contaminated needles.
In 2000 the CDC reported that more than 90 percent of current cases of AIDS in children, and almost all new HIV infections reported in young
U.S. children, resulted from transmission of theHIV virus from the mother to her child during pregnancy, birth, or through breast-feeding. Between 6,000 and 7,000 children are born to HIVinfected mothers each year in the United States.
However, 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 before the baby is born. 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.
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.
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 during sexual activity.
HIV is also spread by sharing needles, syringes, or drug use equipment with someone who is infected with the virus.
This disease results from infection with the human immunodeﬁciency virus (HIV), which infects and destroys a type of white blood cell involved in the body’s immune response to invading germs. By destroying or impairing immune system cells, the virus progressively destroys the body’s ability to ﬁght infections and certain cancers.
Persistent or severe symptoms may not surface for 10 years or more after HIV infection ﬁrst enters the body. This period of the infection varies from person to person, during this time the HIV is infecting and killing cells of the immune system. Its most obvious effect is a decline in the blood levels of CD4+ cells (also called T4 or “helper” cells)—the immune system’s key infection ﬁghters. The virus initially disables or destroys these cells without causing symptoms.
An HIV-infected child is usually diagnosed with AIDS when the immune system becomes severely damaged and other types of infections occur. As the immune system deteriorates, symptoms may include
• fatigue and lack of energy
• fevers and sweats
• enlarged lymph nodes for more than three months
• short-term memory loss
• pelvic inflammatory disease that does not respond to treatment
• persistent skin rashes or ﬂaky skin
• persistent or frequent oral/vaginal yeast infections
• weight loss
Some children develop frequent and severe HERPES infections that cause mouth, genital, or anal sores, or SHINGLES.
There are treatments to slow down the rate at which HIV weakens the immune system, but currently available antiretroviral drugs cannot cure HIV infection or AIDS, and all these drugs have severe side effects.
Some of the nucleoside reverse transcriptase (RT) inhibitors may deplete red or white blood cells, especially when taken in the later stages of the disease; some may also cause an inflammation of the pancreas and painful nerve damage. There have been reports of other severe reactions, including death, to some of the antiretroviral nucleoside drugs when used alone or in combination.
The most common side effects associated with protease inhibitors include nausea, diarrhea, and other gastrointestinal symptoms. In addition, protease inhibitors can interact with other drugs and cause serious side effects.
A major factor in reducing the number of deaths from AIDS in this country has been highly active antiretroviral therapy (HAART). HAART is a treatment regimen that combines reverse transcriptase inhibitors and protease inhibitors to treat AIDS patients.
While HAART is not a cure for AIDS, it has greatly improved the health of many children with AIDS, reducing the amount of virus circulating in the blood to nearly undetectable levels. However, researchers have shown that HAART cannot eradicate HIV entirely from the body.
A number of drugs are available to help treat opportunistic infections to which children with HIV are especially prone. These drugs include foscarnet and ganciclovir to treat cytomegalovirus eye infections, ﬂuconazole to treat yeast and other fungal infections, and trimethoprim/sulfamethoxazole (TMP/SMX) or pentamidine to treat Pneumocystis carinii pneumonia (PCP).
Children can receive PCP preventive therapy when their T-cell counts drop to levels considered below normal for their age group, and they must take drugs for the rest of their lives to prevent an occurrence of the pneumonia.