From the Guidelines
Undiagnosed HIV infection in pediatric patients often presents with non-specific symptoms, such as common bacterial infections, chronic diarrhea with failure to thrive, or delays in development, rather than the typical conditions seen in adults 1.
Clinical Manifestations
- Infants and children with undiagnosed HIV infection are more likely to have:
- Serious bacterial infections, such as pneumococcal disease, herpes zoster, and tuberculosis
- Asthma and chronic lung and skin disease
- Immune thrombocytopenic purpura, anemia, recurrent parotitis, chronic diarrhea, encephalopathy, or stroke
- Up to 20% of perinatal infections may present after 6 years of age in populations without access to prenatal or newborn screening 1.
Diagnostic Challenges
- HIV transmission can occur through sexual abuse, so children with signs and symptoms of HIV should be tested even if their initial testing result as an infant was negative 1.
- Definitive diagnosis of HIV infection in children less than 18 months of age should be based on laboratory evidence of HIV in blood or tissues by culture, nucleic acid, or antigen detection 1.
Management
- 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.
- All HIV-infected children should be vaccinated against pneumococcus and receive yearly trivalent inactivated influenza vaccine 1.
From the Research
Clinical Manifestations of Undiagnosed HIV Infection in Pediatric Patients
The clinical manifestations of undiagnosed Human Immunodeficiency Virus (HIV) infection in pediatric patients can be diverse and non-specific, making diagnosis challenging. Some common manifestations include:
- Failure to thrive 2, 3
- Pulmonary interstitial pneumonitis 2
- Hepatosplenomegaly 2
- Recurrent bacterial infections 2, 3
- Pneumocystis carinii pneumonia (PCP) 3
- Cytomegalovirus infection 3
- Encephalopathy 3
- Thrush 3
- Lymphoid interstitial pneumonitis 3
- Lymphadenopathy 3
- Pancreatitis 3
- Hepatitis 3
- Anemia 3
- Thrombocytopenia 3
Oral and Maxillofacial Manifestations
Oral manifestations of HIV infection can occur at all stages of the disease and include:
- Fungal infections (candidiasis) 4, 5
- Viral infections (herpes, zoster, human papillomavirus) 4, 5
- Bacterial infections (streptococcemia) 4
- Kaposi's sarcoma 4
- Oral warts 4
- Lipodystrophy syndromes 4
Physical Examination Findings
Physical examination findings in pediatric patients with HIV infection may include: