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HIV Infection in Children: Epidemiological and Diagnostic Aspects

AIDS in children is already having a significant impact on child survival in many parts of the world. In Sub Saharan Africa, where an estimated 1 in 40 adult men and women are HIV infected, WHO projects that by the year 2010 infant mortality will be double the estimated figure it would be in the absence of AIDS1. However, although at present the majority of people with AIDS and HIV infection live in Sub Saharan Africa, numbers are increasing at a faster rate in Asia. Worldwide, heterosexual contact is the main mode of transmission and the increasing prevalence among women has major implications for children as transmission from mother to child is the major route by which children acquire infection-. In Europe, by the end of June 1991, reports of 2536 children under 13 years of age with AIDS had been received by the WHO-EC Collaborating Centre on AIDS inpw. This includes 1325 Romanian children with transmission through blood transfusions or needles contaminated with HIV as the main mode of acquisition. Of the remaining 1211 children, 79% acquired infection vertically, and the largest numbers were reported from France, Italy and Spain. Fortytwo per cent of the mothers had a history of intravenous drug use, and 35% had acquired HIV infection through heterosexual contact. In Europe, as in other parts of the world, HIV transmission is becoming increasingly heterosexual. AIDS is a combination of symptoms and signs which manifest late in the course of the infection. Cohort studies in adults report a median time of 8-10 years from infection with HIV to the onset of AIDS4.5. In children, the incubation period may be shorter6, particularly in vertically-infected children, although there is some evidence that a proportion of vertically-infected children survive without AIDS for several years. Therefore, HIV seroprevalence surveys provide more information about the extent of the problem within a population than reports of cases of AIDS. National seroprevalence data are not available in any country, and available information