HIV infections in children

HIV infection in infants and children who acquire it early in life is quite different from HIV infection in adults. The immune deficiency that results occurs in an immunologically naive organism, resulting in a larger role for common pathogens in causing severe infections. The immune deficiency is superimposed on age-related changes in all parts of the immune system so that a CD4 count that would be comforting in an adult or older child is cause for concern in an infant. Manifestations of infection include susceptibility to common and opportunistic infection, but growth failure and neurocognitive delays are much more significant patterns of disease than in adults. Therapy is clearly effective in slowing progression of the disease and, in the case of treatment of the pregnant woman, capable of primarily preventing the infection. The emergency physician's role in the treatment of children with HIV infection includes early identification, management of infections and complications, and advocacy for children who are so often unable to advocate for themselves.