Skin manifestations of HIV-1 infection in children

Abstract

The first pediatric case of AIDS was reported to the Centers for Disease Control and Prevention (CDC) in November 1982, 18 months after the first description of AIDS in adults. It is estimated that 3.5 million women of childbearing age have been infected with HIV-1, and 3000 additional women become infected every day. According to the World Health Organization (WHO), by December 1998, 1.2 million children under the age of 15 years were infected with HIV.1 One million of them live in Africa and in general have been infected through vertical mother-to-child transmission of HIV.1 HIV-1 infection has a significant impact on childhood mortality and morbidity and is one of the leading causes of death, especially among African children. The established modes of transmission of HIV-1 infection are through (1) sexual contact, (2) from mother to infant, and (3) through exposure to infected blood (such as transfusion, needle sharing). Transmission of HIV-1 from mother to child (vertical) is the predominant source of acquisition of HIV-1 in children. Data support the transmission during the antepartum and intrapartum periods as well as postpartum by breastfeeding. Zidovudine given antepartum and intrapartum to the mother and the newborn for 6 weeks reduces the risk of maternal-infant HIV transmission by approximately two thirds2 and is safe.3 Many children, especially hemophiliacs, have been infected through infected blood products, but transfusion-related transmission is now rare in the Western world but still applies for the developing countries. Routes of transmission of HIV in adolescents are similar to those for adults. Several studies revealed that perinatal infection had a more varied clinical picture and a worse outcome than infection acquired later in childhood.4–6 About one third of infants born to HIV-seropositive mothers will have evidence of infection or AIDS by the age of 18 months, and about one fifth of them will die.3,7 Subsequently, the disease progresses more slowly, and most children remain stable or even improve during the second year.8 The diagnosis of HIV-1 infection is a special diagnostic challenge. In 1994 the CDC revised the classification system published in 1987, aiming not only to establish disease surveillance but also to define its progression. In the current classification system, children are grouped into mutually exclusive categories based on three parameters: (1) infection status (exposed, infected, seroconverter; (2) clinical status (asymptomatic, mild, moderate, or severe symptoms); and (3) immunological status (age-related categories of no, moderate, or severe suppression). Reclassification to a less severe category does not occur even if the child’ s clinical or immune status improves. Recent data suggest that determination of the plasma viral concentration (viral load) in conjunction with CD4 cell count are more accurate predictors of prognosis and survival than each marker alone. The viral load 5log10 per ml within the first 30 months of life and 4.3log10 after 30 months are associated with an increased risk of disease progression.9