children s health issues
Human Immunodeficiency Virus (HIV) Infection in Children and Adolescents
Prevention of HIV Infection in Children
See also Preventive treatment after exposure . Current preventive therapy for infected pregnant women is highly effective at minimizing transmission. Pregnant women with HIV infection should begin antiretroviral therapy (ART) by mouth. Ideally, ART should begin as soon as HIV infection is diagnosed and women are ready to follow the therapy as directed. Pregnant women with HIV infection who are already on ART should continue the therapy throughout the pregnancy. Women with HIV infection should also continue ART when trying to get pregnant. (ZDV) is sometimes given by vein (intravenously) to the mother during labor and delivery. ZDV is then given to the HIV-exposed newborn by mouth twice a day for the first 4 to 6 weeks of life (sometimes along with additional antiviral medications for certain newborns at greater risk of acquiring HIV infection). Treatment of mothers and children in this way reduces the rate of transmission from 25% to 1% or less. Also, Cesarean Delivery (c-section) done before labor begins may reduce the newborn's risk of acquiring HIV infection. Doctors may recommend cesarean delivery for women whose infection is not well controlled by ART. After delivery, ART is continued for all women with HIV infection. Because HIV can be transmitted during breastfeeding and in breast milk, the decision to breastfeed should be made only after counseling and decision-making discussions with health care practitioners. In countries where the risks of undernutrition and infection resulting from unclean water or formula are high and safe, affordable infant formula is not available, the benefits of breastfeeding may outweigh the risk of HIV transmission. In these countries, mothers with HIV infection under medical supervision may continue to breastfeed for at least 12 months of the infant's life and then rapidly wean the infant to food. Often their infants are given ART throughout the period of breastfeeding. Mothers with HIV infection should be advised never to donate their breast milk to milk banks. Mothers with HIV infection should not prechew (premasticate) food for infants. Because a child's HIV status may not be known, all schools and day care centers should adopt special procedures for handling accidents, such as nosebleeds, and for cleaning and disinfecting surfaces contaminated with blood. During cleanup, personnel are advised to avoid having their skin come in contact with blood. Latex gloves should be routinely available, and hands should be washed after the gloves are removed. Contaminated surfaces should be cleaned and disinfected with a freshly prepared bleach solution containing 1 part of household bleach to 10 to 100 parts of water. These practices are called universal precautions and are followed not only for children with HIV infection but for all children and in all situations involving blood. Prevention for adolescents is the same as Prevention . All adolescents should have access to HIV testing and should be taught how HIV is transmitted and how it can be avoided, including abstaining from high-risk behaviors (such as sharing infected needles) and sex or using Taking an antiretroviral medicationbeforebeing exposed to HIV can reduce the risk of HIV infection. Such preventive treatment is called pre-exposure prophylaxis (PrEP). PrEP is most effective if people take the medication every day, but it can be expensive, so PrEP is recommended most often for people who are not infected with HIV but who have a high risk of becoming infected, such as people who have a sex partner who is infected with HIV, men who have sex with men, and people who are transgender. Older adolescents at risk may also receive PrEP, but issues of confidentiality and cost are more complex than with adult PrEP. People who use PrEP still need to use other methods to prevent other infections, including consistent use of condoms and not sharing needles to inject drugs. 