Progression of human immunodeficiency virus infection in children is related to the interaction of the virus, the immune system, and then some.

Abstract

It is well recognized that the rate of disease progression in HIV-infected children is generally more accelerated than in adults. However, not all infected children manifest disease pro­ gression in the same manner. Approximately 15-25% of chil­ dren with vertically acquired HIV infection (the nearly uniform route of acquisition) are progressors in that they have dramatic drops in CD4 cell counts and the onset of AIDS­ identifying symptoms (most commonly encephalopathy and Pneumocystis carinii pneumonia) occurs within the first year of life. The largest proportion of children are less rapid pro­ gressors, becoming symptomatic within the first several years of life, albeit with a shorter clinical latency period compared with that in adults (which, on the average, is 8-10 years). A small proportion of children with vertically acquired disease do not become symptomatic until their second decade of life and might be considered slow progressors. The interplay of multiple factors contributes to the different rates of disease progression in children and almost certainly includes the route and timing of infection, the amount and phenotype of the virus, the integrity of the immune system, and the patient's genetic composition.