HIV in children Dr Trisha Macnair Most children with the disease are infected in the womb or during birth.

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What is HIV? Symptoms

Causes and risk factors Treatment and recovery

Advice and support

Human immunodeficiency virus (HIV) is an infection that causes acquired immunodeficiency syndrome (AIDS), a chronic, life-threatening condition.

AIDS occurs when the HIV infection damages or destroys the cells of the immune system, reducing the body's ability to fight off bacterial, viral and fungal infections.

As the immune system fails, the person becomes vulnerable to illnesses they would normally resist (known as opportunistic infections), such as pneumonia, meningitis, intestinal infection and certain types of cancers.

HIV in children is uncommon in Europe and the UK. However, it is estimated that over 2 million children worldwide have HIV, most of them are in sub-Saharan Africa.

The initial infection with HIV may cause a brief flu-like illness two to six weeks after infection, with symptoms such as fever, headache, sore throat and swollen lymph glands.

However, many people don't show any particular symptoms and children are often infected while in the womb.

There appear to be two general patterns of illness in HIV-infected children.

• About 20 per cent develop serious disease in the first year of life, most of whom die by the age of four
• In the remaining 80 per cent, the disease progresses more slowly

Children with HIV often fail to gain weight and don't grow properly. They may develop problems with walking, or show delayed mental development.

Like adults, children are vulnerable to opportunistic infections and normal childhood infections can be severe.

Swollen lymph glands may be the first sign of AIDS. Other symptoms may include:

• Weight loss
• Diarrhoea
• Fever
• Cough
• Weakness
• Shortness of breath
• Headaches
• Night sweats
• Visual problems
• Dementia
• Development of a variety of cancers

If untreated, these problems and related complications may be rapidly fatal.

In the majority of cases of children with HIV, the virus has been transmitted from the mother during pregnancy or birth, or through breastmilk.

Among adults, HIV is most commonly spread by sexual contact with an infected partner. It can also be spread through infected blood and contaminated needles or syringes.

HIV is usually diagnosed using a blood test that detects antibodies to the virus. It can take up to 12 weeks after infection for these antibodies to be made, so an HIV test may, initially, be negative.

All children born to infected mothers receive some of their mother's antibodies to HIV across the placenta. These may persist for up to 18 months, making antibody tests inaccurate.

Newer blood tests can detect tiny quantities of the virus in the infant's blood, giving an accurate diagnosis in about 95 per cent of HIV-infected infants by three months of age.

AIDS is defined as a positive test for HIV combined with either an opportunistic infection (an infection that only occurs when your immune system isn't working properly, such as pneumocystis carinii pneumonia) or an abnormally low level of a type of white blood cell called a CD4 lymphocyte.

A count of 200 or less is abnormal - normal levels range from 600 to 1,000.

Children may also have more severe forms of common childhood bacterial infections, such as conjunctivitis (pink eye), ear infections and tonsillitis.

Drug treatments, using a combination of several drugs known as highly active antiretroviral therapy, have greatly improved the outlook for people AIDS. But drugs can't cure the infection, and side-effects and drug resistance are still a major problem. The drugs are also not available to everyone in the developing world.

Other therapies can greatly improve quality of life.

The risk of transmission of HIV from a mother to her child can be reduced to 2% with successful interventions. (However, these interventions are not widely available in the developing world.)

Choosing an elective caesarean delivery and, when possible, avoiding breastfeeding may also help to reduce the risk.

Children with AIDS
Tel: 020 7247 9115
Email: info@cwac.org
Website: www.cwac.org

Children's HIV Association of UK and Ireland
Website: www.chiva.org.uk

Avert
Email: info@alert.org
Website: www.avert.org

National AIDS Trust
Tel: 020 7814 6767
Email: info@nat.org.uk
Website: www.nat.org.uk

This article was last medically reviewed by Dr Orlena Kerek in March 2009