children s health issues
Human Immunodeficiency Virus (HIV) Infection in Children and Adolescents
Treatment of HIV Infection in Children
Antiretroviral medications Ongoing monitoring Encouraging adherence to treatment All children with HIV infection should be given antiretroviral therapy (ART) as soon as possible, ideally within 1 to 2 weeks of diagnosis. Children are treated with most of the same antiretroviral medications as adults (see Antiretroviral Treatment of Human Immunodeficiency Virus (HIV) Infection ). However, not all of the medications used for older children, adolescents, and adults are available to young children, in part because some are not available in liquid form. ART is tailored to the child, but combinations typically consist of the following: Two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)plus either An integrase inhibitorora protease inhibitor Sometimes a non-nucleoside reverse transcriptase inhibitor is given with two NRTIs. In general, children develop the same types of side effects as adults but usually at a much lower rate. However, the side effects of medications may also limit the treatment. A doctor monitors the effectiveness of treatment by regularly measuring the amount of virus present in the blood ( Viral load ) and the child's CD4+ cell count (see Increased numbers of virus in the blood may be a sign that the virus is developing resistance to the medications or that the child is not taking the medications. In either case, the doctor may need to change the medications. To monitor a child's progress, the doctor examines the child and does blood tests on the child at 3- to 4-month intervals. Other blood tests and urine tests are done at 6- to 12-month intervals. Adherence is taking medications as directed. Adhering to prescribed ART dosing schedules is extremely important. If children take ART medications less often than they are supposed to, the HIV in their system can rapidly become permanently resistant to one or more of the medications. Yet, it may be difficult for parents and children to follow and adhere to complicated medication regimens, which can limit the effectiveness of therapy. To simplify regimens and improve adherence, tablets containing three or more medications may be given. These tablets may need to be taken only once or twice a day. The liquid forms of medications are now better-tasting, which improves adherence. Adherence to ART may be more difficult for adolescents than for younger children. Adolescents also have difficulty adhering to treatment regimens for other chronic diseases such as diabetes and asthma (see also Chronic Health Problems in Children ). Adolescents want to be like their peers and can feel set apart by their illness. Skipping or stopping treatment may be a way for them to deny having an illness. Additional issues that may complicate treatment and reduce adherence in adolescents include Low self-esteem A chaotic and unstructured lifestyle Fear of being singled out because of illness Sometimes a lack of family support In addition, adolescents may not be able to understand why medications are necessary when they do not feel ill and they may worry greatly about side effects. Despite frequent contact with a pediatric health care team, adolescents who have been infected since birth may fear or deny their HIV infection or distrust information provided by the health care team. Instead of directly confronting adolescents who have poor support systems about the need to take their medications, care teams sometimes help the adolescent focus on practical matters such as how to avoid opportunistic infections and how to obtain information about reproductive health services, housing, and succeeding in school (see Transition to Adult Care ). To prevent Pneumonia in Immunocompromised People , doctors give to prevent Mycobacterium avium Complex (MAC) Infections , depending on their age and Nearly all children infected with HIV should receive the Childhood Vaccination Schedules , including Diphtheria-Tetanus-Pertussis Vaccine (DTaP) Polio Vaccine None Influenza Vaccine (inactivated, not live vaccine) Haemophilus influenzae Type b Vaccine None Pneumococcal Vaccine None Hepatitis A Vaccine and Rotavirus Vaccine None Meningococcal Vaccine None Pneumococcal Vaccine None COVID-19 Vaccine None Yearly inactivated or live influenza immunization is also recommended for household members. Some vaccines containing live bacteria, such as bacille Calmette-Guérin (which is used to prevent tuberculosis in some countries outside the United States), or live viruses, such as the oral polio virus (not available in the United States but still used in other parts of the world), varicella, and measles-mumps-rubella, can cause a severe or fatal illness in children with HIV whose immune system is very impaired. However, the live Measles, Mumps, and Rubella Vaccine , live However, the effectiveness of any vaccination is less in children with HIV infection. Children infected with HIV who have very low CD4+ cell counts are considered susceptible to vaccine-preventable diseases when they are exposed to one (such as measles, tetanus, or varicella) regardless of whether they have received the vaccine for that disease and may be given immune globulin by vein (intravenously). Intravenous immune globulin or immediate vaccination with measles-mumps-rubella vaccine also should be considered for any nonimmunized household member who is exposed to measles. For children in child care or school, or if a child needs foster care, a doctor can help assess the child's risk of exposure to infectious diseases. In general, transmission of infections, such as chickenpox, to children with HIV infection (or to any child with an impaired immune system) is more of a danger than is transmission of HIV from that child to others. However, a young child with HIV infection who has open skin sores or who engages in potentially dangerous behavior, such as biting, should not attend child care. Children with HIV infection should participate in as many routine childhood activities as their physical condition allows. Interaction with other children enhances social development and self-esteem. Because of the stigma associated with the illness, the routine use of universal precautions in schools and day care centers, and the fact that transmission of the infection to other children is extremely unlikely, there is no need for anyone other than the parents, the doctor, and perhaps the school nurse to be aware of the child's HIV status. As a child's condition worsens, treatment is best given in the least restrictive environment possible. If home health care and social services are available, the child can spend more time at home rather than in a hospital. 