children s health issues
Human Immunodeficiency Virus (HIV) Infection in Children and Adolescents
Prognosis for HIV Infection in Children
Before antiretroviral therapy (ART), 10 to 15% of children from high-income countries and perhaps 50 to 80% of children from low-income or middle-income countries died before 4 years of age. Today, with ART, most children born with HIV infection live well into adulthood. Increasing numbers of these young adults who were infected at birth have given birth to or fathered their own children. It is unknown whether HIV infection itself or ART given to children infected with HIV during critical periods of growth and development will cause additional side effects that appear later in life. However, so far, no such side effects have been noted in children infected at or before birth who were treated with ART and who are now young adults. Because of the way HIV remains hidden within people's cells, medications do not completely eliminate the virus from the body. Even when tests do not detect the virus, some viruses remain within cells. In one instance, a child who was born to an untreated mother infected with HIV was given high doses of ART. Although the ART was unintentionally interrupted when the child was 15 months of age, at 24 months of age, doctors were still not able to detect reproducing (replicating) HIV in the child. However, doctors were able to detect the virus later. Research studies are underway to find out whether giving high doses of ART to suppress the virus, even if only for a short time, leads to better health. Doctors do recommend that people of any age do not interrupt their ART. If children with HIV do not receive antiretroviral medications, opportunistic infections occur, particularlyPneumocystispneumonia, and the prognosis is poor.Pneumocystispneumonia causes death in 5 to 40% of treated children and in almost 100% of untreated children. The prognosis is also poor for children in whom the virus is detected early (within the first week of life) or who develop symptoms in the first year of life if they do not receive ART. To date, there is no cure for HIV infection, and it is not yet known if a cure is possible. What is known, however, is that HIV infection is a treatable infection and that long-term survival is possible if effective ART is given. 