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Human immunodeficiency virus infection in children
1Department of Clinical Pharmacy Services, Cook County Hospital, Chicago, IL, USA.
Insights
This review covers pediatric human immunodeficiency virus (HIV) infection, including transmission, diagnosis, and clinical features. It discusses zidovudine as a primary treatment and other therapies for children, alongside prophylaxis against opportunistic infections.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Clinical Pharmacology
Background:
- Human Immunodeficiency Virus (HIV) infection in children presents unique challenges in transmission, diagnosis, and management.
- Perinatal transmission accounts for the vast majority of pediatric HIV cases, highlighting the importance of early intervention.
- Clinical manifestations in children are diverse, ranging from failure to thrive to opportunistic infections and neurological complications.
Purpose of the Study:
- To review the transmission routes, diagnostic methods, and clinical spectrum of HIV infection in children up to 13 years of age.
- To discuss current and emerging drug therapies, including maintenance and prophylactic treatments for pediatric HIV.
- To provide an overview of the role of zidovudine and alternative treatment strategies in managing pediatric HIV.
Main Methods:
- Review of existing literature on pediatric HIV transmission, diagnosis, and clinical management.
- Analysis of diagnostic assays such as HIV culturing, PCR, ELISA, Western blot, and p24 antigen testing.
- Evaluation of therapeutic agents including zidovudine, didanosine, and investigational drugs, as well as prophylactic measures.
Main Results:
- HIV is primarily transmitted from mother to infant, with diagnosis recommended starting at one month of age.
- Common clinical features include Pneumocystis pneumonia, failure to thrive, and encephalopathy, with a median AIDS diagnosis age of 12-24 months.
- Zidovudine is the preferred initial therapy, with didanosine as a second-line option; prophylaxis against opportunistic infections is crucial.
Conclusions:
- Early diagnosis and treatment initiation are critical for improving outcomes in pediatric HIV infection.
- Zidovudine remains a cornerstone of therapy, but combination therapies and new agents are under investigation.
- Prophylaxis against opportunistic infections and adherence to immunization schedules are essential components of comprehensive care for HIV-infected children.
Abstract:
The transmission, diagnosis, and clinical manifestations of human immunodeficiency virus (HIV) infection in children up to 13 years of age are reviewed, and maintenance and prophylactic drug therapies for these patients are discussed. HIV can be transmitted from mother to infant in utero, during delivery, or through breast milk. Perinatal transmission accounts for almost 90% of all pediatric HIV infections. HIV infection can be diagnosed with HIV culturing, polymerase chain reaction testing, the enzyme-linked immunosorbent assay, the Western blot antibody assay, or the p24 core-antigen assay. Testing should begin as soon as possible after the at-risk child reaches one month of age. CD4+ lymphocyte counts are also used in diagnosis and monitoring. The median age at diagnosis of AIDS in children with perinatally acquired HIV infection is 12-24 months. Among the many possible clinical features are Pneumocystis carinii pneumonia (PCP), cytomegalovirus infection, failure to thrive, encephalopathy, recurrent bacterial infection, thrush, lymphoid interstitial pneumonitis, lymphadenopathy, pancreatis, hepatitis, anemia, and thrombocytopenia. Zidovudine is considered the drug of choice for initial therapy in HIV-infected children and is indicated for asymptomatic infection, early symptomatic disease, and advanced disease. However, new research is questioning the role of zidovudine monotherapy. Didanosine is the only agent with FDA-approved labeling for use as second-line therapy in children who do not respond to or become resistant to zidovudine. Agents under investigation for pediatric use are zalcitabine, stavudine, lamivudine, and nevirapine. Drug combinations, such as zidovudine plus didanosine, are also being examined. Zidovudine appears to reduce the rate of maternal transmission of HIV. Agents used prophylactically against PCP in children are trimethoprim-sulfamethoxazole, dapsone, and inhaled or i.v. pentamidine. HIV-infected children should also received prophylaxis against recurrent bacterial infections. The standard pediatric immunization schedule is used, but inactivated injectable poliovirus vaccine must be given instead of the live oral vaccine. Zidovudine remains the first-line agent for treating HIV infection in children. Alternatives are available for those who do not respond to zidovudine.