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The seventh leading cause of death in children ages 1 - 14 is HIV.HIV disease progression normally follows two distinct pathways amongst children. It has been estimated that approximately 20% of children infected with HIV will develop a serious illness (Opportunistic Infection) in the first year and most will die by the age of 4. The other 80% of children will experience a slower progression of the disease and may not suffer any serious illness well into their early adolescence.
Transmittance:
Children may acquire HIV in the same manner as adults (i.e. infected fluid contamination), but children are unique in that they may acquire HIV from prenatal transference from an infected mother or from breastfeeding after birth from an infected mother.
Transmission from an infected mother to the unborn fetus is termed vertical transmission..This form of transmission may occur at birth by exposure to blood and vaginal fluids, or even as early as the 2nd or 3rd trimesters of pregnancy via the placenta. Factors that increase the risk of vertical transmission include inflammation of fetal membranes, drug use by the mother, and membrane rupture during delivery. Currently there is a 20% to 40% infection rate from mother to infant, although this trend may be decreasing due to alternative birth procedures and other treatments. Vertically infected infants will express symptoms of HIV within the first year of life (approximately four to five months), unlike their adult counterpart.
Differences Between Infections in Adults & Children:
Generally in adults, the time frame from infection of HIV to the expression of infection is on average 10 years. However, with children this expression occurs much sooner. Children's survival time after being diagnosed with AIDS is also much shorter than that of adults. In the case of vertical transmission, this rapid onset of symptoms may be attributed to a weaker or underdeveloped immune system in conjunction with a high direct viral load from the mother. Most infants infected with HIV will develop symptoms within one year (approximately 70%) and it is estimated that approximately 17% will die within that year. Children may also express symptoms earlier than adults due to their lack of previous exposure to certain opportunistic infections (i.e. pneumonia). The progression of HIV depends on two main factors: the strain of the virus and the dose of the virus received.
An HIV infection affects a child in different ways than adults. For example, children may experience developmental delays and also "fail to thrive"; meaning that they simply do not develop physically whereas adults usually waste away (anorexia).
Children also suffer from both the same and different opportunistic infections (OI) than adults. For example, the most common OI affecting children is Lymphoid Interstitial Pneumonia whereas in adults the most common OI's include Kaposi's sarcoma, lesions, pneumonia, etc. Children also suffer from a pulmonary disease termed pulmonary lymphoid hyperplasia which causes low oxygen levels in the blood eventually causing death and is usually not seen in adults.
Psychological & Social Ramnifications of AIDS:
Not only does the child have to endure the physical changes brought on by AIDS, but there are severe psychological and social changes as well. For example, deciding when to disclose the information and with whom to disclose the information that the child is HIV positive. Also, children must deal with the fact that they are a risk factor and might feel embarrassed about their disease, thus diminishing their self-esteem and damaging/preventing potential relationships. Children must also face their own death much sooner and must try to understand what the process of dying involves; something most people challenge in their 70's as opposed to their first few years of life.
Treatments:
Currently there is no vaccine for the HIV virus. However, the use of pediatric anti-HIV drug therapy combinations is steadily increasing and the results are promising. For example the newborn may be administered high doses of anti-viral AZT shortly after birth in the hopes that seroconversion may be prevented.
To combat vertical transmission, research has demonstrated that if the pregnant mother administers an aggressive anti-HIV drug therapy, the tranmission rate of HIV into her child could be as low as 8%.
Preventative Measures & Intervention:
The only 100% effective preventative measure to combat HIV is education. Because there is no known cure or vaccine for this virus, the only way to stop HIV is to prevent others from becoming infected.
If a pregnant mother is HIV positive and her viral load is high, one preventative measure to decrease the possibility of transmission to newborn is an elective cesarean. If the pregnant mother has received anti-HIV drug therapy by the 34 week of her pregnancy and she chooses to do an elective cesarean, the transmission rate of HIV into her child could be as low as 3%. Elective cesareans are not common and are used only in cases where the mother's viral load is high increasing the risk of transmission of HIV to baby.
