Preventing and Managing HIV Infection in Infants, Children, and Adolescents in the United States

Abstract

Objectives After completing this article, readers should be able to: Recognize the important role that the pediatrician plays in the prevention, detection, and care of human immunodeficiency virus (HIV)-infected and -affected patients. Know the epidemiology of human immunodeficiency virus infection in infants, children and adolescents. Select the proper HIV diagnostic testing plan for infants, children and adolescents. Plan the comprehensive management of HIV-exposed infants. Recognize the clinical conditions suggestive of HIV infection, including the major opportunistic infections seen in patients with HIV/AIDS. Understand the principles, monitoring, and complications of HIV treatment in infants, children and adolescents. Practice Gap Effective prevention strategies have reduced the risk of perinatal transmission of HIV infection to less than 1–2% in the United States, but failures to fully implement these strategies result in continued, preventable infant HIV infections. In addition, the rising number of sexually acquired HIV infections in adolescents underscores the important role of the pediatrician in preventing and diagnosing HIV infection in youth.

Diagnosis of Human Immunodeficiency Virus Infection

“…Studies have shown that if these infants are left untreated, about 35% and 52% of the infants die before the ages of 1 and 2 years, respectively (258). With PMTCT interventions, including early ART intervention in infected pregnant women and prophylactic ARV treatment in exposed infants, vertical transmission of HIV was drastically reduced from 35% to less than 2% in developed countries (259,260). Early diagnosis of infection in HIV-exposed infants (HEI) provides a unique opportunity to strengthen these infants' follow-up and linkage to ART as well as the provision of prophylaxis, such as co-trimoxazole, for opportunistic infections and ART.…”

HIV prevalence and risk factors in infants born to HIV positive mothers, measured by dried blood spot real-time PCR assay in Tigray, Northern Ethiopia

“…To further reduce and prevent the risk of MTCT and have an AIDS-free generation, early virological testing is critical for identifying infected infants and to strengthen the quality of HIV-exposed infant follow-up (http://www.ilo.org/wcmsp5/groups/public/%2D%2D-ed_protect/%2D%2D-protrav/%2D%2D-ilo_aids/documents/legaldocument/wcms_125389.pdf). Positive HIV antibody test in an infant indicates maternal but not necessarily infant HIV infection [9].…”

Problems of the Newborn and Infant

“…Effective prevention strategies have reduced the risk of perinatal transmission of HIV infection to less than 1-2% in the United States; however, failures to fully implement these strategies have resulted in vertically transmitted infant HIV infections. All pregnant women should be screened for HIV, and repeat testing at the time of delivery is suggested in high-risk situations or individuals [22,23].…”

“…In the absence of antiretroviral preventive interventions, in nonbreastfeeding populations, 25-30% of infants born to HIV-infected women will become infected. Rates can be as high as 50% for infants with prolonged breastfeeding [22,23].…”

“…The usual dose for gestational age 35 weeks is 4 mg/kg/ dose orally twice daily for 6 weeks. Dosing varies for preterm infants (<35 weeks) [22,23].…”