pediatrics
Human Immunodeficiency Virus (HIV) Infection in Infants and Children
Epidemiology of HIV Infection in Infants and Children
In the United States, since HIV infection was first recognized, more than 10,000 cases have been reported in children and young adolescents, but this number represents only 1% of total cases. In 2019, < 60 new cases were diagnosed in children < 13 years of age ( Epidemiology references ). More than 95% of US children with HIV infection acquired the infection from their mother, through either antenatal or perinatal transmission (also called vertical transmission or mother-to-child transmission [MTCT]). Most of the remainder (including children with hemophilia or other coagulation disorders) received contaminated blood or blood products. Some cases were the result of sexual abuse. MTCT has declined significantly in the United States from approximately 25% in 1991 (resulting in > 1600 infected children annually) to ≤ 1% in 2019 (resulting in approximately 50 children infected annually). MTCT has been reduced by using comprehensive serologic screening and treating of infected pregnant women during both pregnancy and delivery and by providing short-term antiretroviral prophylaxis to exposed newborns. Approximately 3000 to 5000 pregnant women with HIV infection give birth annually in the United States, so attention to preventing MTCT remains critical in preventing HIV infection in infants and children. Although the number of children infected annually has decreased, the total number of US adolescents and young adults (13 to 24 years of age) with HIV infection continues to increase despite the marked success in decreasing perinatal HIV infection. In 2019, about 36,000 new cases of HIV infection in the United States were diagnosed; 20% of these were among adolescents and young adults 13 to 24 years of age (the majority of whom were 18 years of age or older) ( Epidemiology references ). This paradoxical increase in the number of children and adolescents with HIV infection is a result of both greater survival rates among perinatally infected children and new cases of HIV infection acquired via sexual transmission among other adolescents and young adults (in particular, among young men who have sex with men). Reducing transmission of HIV among young men who have sex with men continues to be an important focus of domestic HIV control efforts as is continuing the reduction of MTCT. Worldwide, in 2021, about 1.7 million children < 14 years old had HIV infection (4% of the total caseload worldwide) ( Epidemiology references ). Each year, about 160,000 more children are infected (10% of all new infections), and about 100,000 children die. Although these numbers represent a daunting amount of illness, new programs created to deliver antiretroviral therapy (ART) to pregnant women and children have reduced the annual number of new childhood infections and childhood deaths by 33 to 50% in the past few years ( Epidemiology references ). However, infected children still do not receive ART nearly as often as adults, and 1.Centers for Disease Control and Prevention: HIV Surveillance Report, 2020. Vol. 33. Published May 2022. Accessed 11/29/2022. 2.UNAIDS: Global HIV & AIDS statistics—Fact sheet. Accessed 12/19/2022. 