Pediatric human immunodeficiency virus infection and disease

Abstract

Because almost all pediatric human immunodeficiency virus (HIV) infection is perinatally acquired, the geometric increase in acquired immunodeficiency syndrome cases in women is reflected in a corresponding increase in HIV infection in children. The pathogenesis of HIV infection in children often involves immune complex phenomenon with elevation of tumor necrosis factor and B-cell abnormalities. Most diagnostic assays (polymerase chain reaction, HIV culture, in vitro HIV-specific antibody production, and HIV-specific IgA) are sensitive in testing infants 6 months of age or older. Previous impressions that HIV infection in infants always progresses rapidly to death have been refuted. Infectious complications include primary bacteremia, acute pneumonia, and sinusitis. Opportunistic pathogens include Pneumocystis carinii, Candida, and Mycobacterium species, and cytomegalovirus. Although malignancies are not common in these children, B-cell malignancies have been reported. Central nervous involvement is much more common in children than in adults with HIV infection. Treatment options for HIV-infected children include intravenous immunoglobulin prophylaxis for P. carinii pneumonia, zidovudine, dideoxyinosine, and dideoxycytidine.