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Pulmonary infections in children with HIV infection
Sayonara Pérez Mato1, Russell B Van Dyke
1Department of Pediatrics, Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, LA 70112, USA.
Insights
Pediatric acquired immunodeficiency syndrome (AIDS) caused opportunistic infections in children. Advances in treatment and prevention have decreased these infections, but pulmonary issues persist in pediatric human immunodeficiency virus (HIV) cases.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Public Health
Background:
- The pediatric acquired immunodeficiency syndrome (AIDS) epidemic in the US (mid-1980s-early 1990s) featured opportunistic infections (OIs) in children with human immunodeficiency virus (HIV).
- Pneumocystis carinii pneumonia (PCP) in infancy caused significant morbidity and mortality, alongside other OIs like bacterial infections, cytomegalovirus, and Mycobacterium avium complex (MAC).
- Many OIs affected the lower respiratory tract, either primarily or as part of disseminated disease.
Purpose of the Study:
- To review the changing landscape of opportunistic infections in pediatric HIV in the US.
- To highlight the impact of medical advancements on the frequency of OIs.
- To emphasize the continued relevance of pulmonary manifestations in pediatric HIV.
Main Methods:
- Literature review of pediatric HIV/AIDS epidemiology and clinical manifestations in the US.
- Analysis of trends in opportunistic infections and pulmonary disease.
- Examination of the impact of prevention strategies and antiretroviral therapy.
Main Results:
- A dramatic decrease in OIs and severe HIV manifestations in US children since the mid- to late 1990s.
- Key factors include reduced mother-to-child HIV transmission, PCP prophylaxis guidelines, and highly active antiretroviral therapy (HAART).
- Fewer children are at risk for clinical progression and OIs, yet pulmonary OIs and disease remain common.
Conclusions:
- Significant progress has been made in managing pediatric HIV, reducing the burden of opportunistic infections.
- Continued vigilance and management are necessary, as pulmonary complications persist in the pediatric HIV population.
- Advancements in prevention and treatment have transformed the prognosis for children with HIV.
Abstract:
The epidemic of pediatric acquired immunodeficiency syndrome (AIDS) in the United States, which peaked during the mid-1980s and early 1990s, was characterized by a variety of opportunistic infections in children infected with human immunodeficiency virus (HIV), often as the presenting illness of their HIV infection. Pneumocystis carinii pneumonia (PCP) during infancy was responsible for significant morbidity and mortality, followed by many other opportunistic infections, including recurrent, serious bacterial infections; disseminated cytomegalovirus infection; and disseminated Mycobacterium avium complex (MAC) infection. Many of these infections involve the lower respiratory tract either as a primary site of infection or as one of the sites involved in disseminated disease. Since the mid- to late 1990s, the pediatric HIV epidemic in the United States has witnessed a dramatic decrease in the frequency of most opportunistic infections and other severe manifestations of HIV infection in children, primarily because of lower rates of mother-to-child HIV transmission, development and implementation of guidelines for PCP prophylaxis, and availability of highly active antiretroviral therapy. Far fewer children are at risk for clinical progression of HIV disease and for opportunistic infections. Despite these successful trends, pulmonary opportunistic infections and pulmonary disease remain common clinical manifestations of pediatric HIV disease.