Diagnosis of Human Immunodeficiency Virus Infection in Infants and Children

Abstract

Since its initial description at the beginning of this decade,1-3 the acquired immunodeficiency syndrome (AIDS) has become one of the major medical, public health, and social issues of our times. Since the isolation of the retrovirus human immunodeficiency virus (HIV) from patients with AIDS and AIDS-related complex,4,5 major advances have been made in understanding the biology of the virus and the disease it causes. Diagnosis of HIV infection in adults and older children, and screening of blood products, have become routine and reliable with the use of licensed tests that detect HIV-specific antibody.6 Antiretroviral drugs, as well as new agents active against AIDS-associated opportunistic infections, have been developed and the first steps in the treatment of HIV infection and its associated illnesses have been taken. Whereas most HIV infection has occurred in adults, it has become an increasing problem among children, particularly in certain geographic areas and populations, reflecting the changing nature of the epidemiology of the disease in the United States. In contrast with the early predominance among homosexual males,7 at present the most significant increases in both HIV infection and AIDS are occurring in users of illicit intravenous drugs, in heterosexual contacts of infected individuals, and in infants born to HIV-infected mothers.8 Nationwide the prevalence of HIV infection in childbearing women remains low; however, rates as high as 1% to greater than 4% have been reported from some urban areas.9,10 Although widely disparate rates of vertical transmission have been reported,11 ongoing prospective studies indicate that the rate of transmission from HIV-infected mother to infant appears to be in the range of 24% to 35%.12-14