From the Guidelines
Early Signs of HIV Infection in Pediatric Patients
The early signs of HIV infection in pediatric patients can be non-specific and may resemble common childhood illnesses, but infants and children with undiagnosed HIV infection are more likely to present with common bacterial infections, chronic diarrhea with failure to thrive, or delays in development.
Common Presentations
- Common bacterial infections
- Chronic diarrhea with failure to thrive
- Delays in development
- Serious bacterial infections, such as pneumococcal disease, herpes zoster, and tuberculosis 1
- Asthma and chronic lung and skin disease
- Immune thrombocytopenic purpura, anemia, recurrent parotitis, chronic diarrhea, encephalopathy, or stroke in some cases 1
Diagnostic Considerations
HIV infection can be definitively diagnosed in most infected infants by age 1 month and in virtually all infected infants by age 6 months using viral diagnostic assays 1. Diagnostic testing should be performed before the infant is aged 48 hours, at age 1-2 months, and at age 3-6 months 1.
Management
All HIV-infected infants should undergo HIV resistance testing and initiate therapy in the first year of life regardless of CD4 cell count, RNA level, or clinical status 1. Antiretroviral therapy should be initiated in all symptomatic children 1. HIV-infected infants and children should be managed by a specialist with knowledge of the unique therapeutic, pharmacologic, behavioral, and developmental issues associated with this disease 1.
From the Research
Early Signs of HIV Infection in Pediatric Patients
The early signs of Human Immunodeficiency Virus (HIV) infection in pediatric patients can be varied and non-specific, making early diagnosis challenging. Some of the possible clinical features of HIV infection in children include:
- Pneumocystis carinii pneumonia (PCP) 2
- Cytomegalovirus infection 2
- Failure to thrive 2
- Encephalopathy 2
- Recurrent bacterial infections 2
- Thrush 2
- Lymphoid interstitial pneumonitis 2
- Lymphadenopathy 2
- Pancreatitis 2
- Hepatitis 2
- Anemia 2
- Thrombocytopenia 2
Importance of Early Diagnosis
Early diagnosis and treatment of HIV infection are crucial in improving the quality and duration of life in HIV-infected children 3, 2. The median age at diagnosis of AIDS in children with perinatally acquired HIV infection is 12-24 months 2. Point-of-care testing can facilitate early infant diagnosis and treatment initiation, which improves outcomes 4.
Transmission and Diagnosis
HIV can be transmitted from mother to infant in utero, during delivery, or through breast milk, with perinatal transmission accounting for almost 90% of all pediatric HIV infections 2. HIV infection can be diagnosed using various tests, including HIV culturing, polymerase chain reaction testing, the enzyme-linked immunosorbent assay, the Western blot antibody assay, or the p24 core-antigen assay 2. Testing should begin as soon as possible after the at-risk child reaches one month of age 2. CD4+ lymphocyte counts are also used in diagnosis and monitoring 2.