Unfortunately, the human immunodeficiency virus (HIV) is an old acquaintance in society at large. THE World Health Organization (WHO) estimates that, at the end of 2019, around 38 million people worldwide were HIV positive. HIV in children and adolescents should not be underestimated as 600,000 newborns are infected each year.
In 2016, an estimated 1.8 million children under 15 were living with HIV worldwide. Eighty-seven percent of these newborns live in sub-Saharan Africa, as there are an estimated 2,000 childhood HIV-positive patients in the United States, nearly all infected before birth.
As you can see, the prevalence of HIV in these stages depends almost entirely on the socioeconomic status, resources and sexual education received in the population studied. To find out more, please continue reading.
Keys to HIV
A publication in Transfusion medicine and hemotherapy provides a series of useful data to understand, in a general way, what the human immunodeficiency virus (HIV) is. We are facing a family lentivirus Retroviridae, subfamily Orthoretrovirinae.
It is an RNA viral agent with a nucleocapsid and an outer lipid bilayer, with a total diameter of approximately 100 nm. We will not focus on the complex mechanism of action of this virus, as it is enough for us to know that it attacks the host’s CD4 lymphocytes, white blood cells essential for the functioning of the immune system.
HIV enters lymphocytes, integrates its genome into cellular DNA, multiplies, assembles and acquires its pathogenicity outside the cell.
The stages of HIV
Throughout the process, HIV destroys the lymphocytes it colonizes. As indicated in an article published in Information about HIV, There are 3 stages of infection. These are the following:
- Acute HIV infection: it is the first stage and occurs 2 to 4 weeks after the acquisition of the virus. During this phase, the patient may experience flu-like symptoms, as the viral concentration in the blood is very high and the activity of the pathogen is at its highest. Therefore, the risk of transmission is very high.
- Chronic HIV infection: The virus continues to replicate and cause damage in the host, but at very low plasma concentrations. This pathogen continues to gradually destroy lymphocytes and multiply, but usually does not cause symptoms until about 10 years after infection.
- AIDS: AIDS and HIV are not the same thing. By this time, the virus has almost completely destroyed the immune system, as CD4 lymphocyte counts are less than 200 units per cubic millimeter of blood. To give you an idea, the normal number is between 500 and 1500. At this point, opportunistic infections usually kill the patient.
Thanks to antiretroviral therapy (ART), a patient can remain in the chronic phase for decades and may even never develop AIDS. Furthermore, those patients who take ART in adequate doses have viral concentrations in their blood so low that they cannot transmit the disease. For practical purposes, they are almost healthy people.
What causes HIV in children and adolescents?
Now you know what the mechanism of HIV is, so we can continue. In adults, most infections are caused by contact with an HIV-positive person’s sexual fluids.
Infections have also been detected through contact of secretions with injuries, blood transfusions, artificial insemination or organ transplants, although this is not the norm.
All these data make us ask the following: how can a child be born infected with the human immunodeficiency virus? The medical portal The BMJ it helps to get an answer.
Transmission during pregnancy
Nearly 2 million children are estimated to be living with HIV today, most of them in Africa. In high-income countries, where the health infrastructure is solid, almost all cases are caused by perinatal transmission, ie during the development of the fetus (73% of cases).
It is a very common vertical transmission mechanism in poor countries, as in some regions up to 40% of pregnant women have HIV and 25-48% of children end up infected before reaching the world. Because the maternal placenta is irrigated and in direct contact (and exchange) with the fetus, the virus can easily infect the baby.
However, it should be noted that not all HIV-positive mothers transmit the virus to their offspring. Second World Health Organization (WHO), the risk is estimated at 15-25%, depending on the state of the mother and her possible (or absent) treatment.
Through contact with breast milk
In regions where breastfeeding is common, up to 1/3 of childhood infections are linked to it. Oddly enough, if the mother breastfeeds her baby up to 18-24 months of life, the risk of contracting HIV is almost 45%.
other mechanisms
Though less common, it’s also possible for a child to become infected early in life through contact with a dirty needle, transfusions of infected blood, or sexual contact with a sick person. Difficult as it may seem, we must bear in mind that abuse and rape also exist in children.
Symptoms of HIV in children and adolescents
HIV infection in children and adolescents differs markedly from the clinical picture presented in adult patients. To postulate this statement, we rely on a number of scientifically proven pillars. These are the following:
- The disease progresses much faster in children, especially if they are newborns. In Africa, 53% of HIV-positive children die before age 2.
- Newborns have higher sustained viral loads than adults.
- Children suffer from opportunistic bacterial or fungal infections much more frequently due to immunosuppression. A clear example of this is thrush or oral candidiasis, typical in immunocompromised patients.
As stated in a publication in Children’s health information, a child with HIV will show below average growth and weight, recurring infections (of the skin, gastrointestinal or respiratory tract), white mouth (disease infection), candida albicans), swollen lymph nodes, diarrhoea, fever and considerable failure to thrive.
diagnostic tests
Candies to suspect of an HIV infection before the baby is born. It’s possible to do it test HIV-positive as soon as the birth takes place, since it takes no more than a few hours to obtain results.
In children older than 18 months and adolescents, HIV tests are the same as in adults. These consist of searching the patient’s blood for both antigens and antibodies against the virus.
In newborns, however, genetic testing (PCR) is required to demonstrate the existence of genetic material of the virus in the newborn’s blood.
Whether infected or not, a newborn baby will always have its mother’s antibodies in its blood. Therefore, techniques for adults are not valid for children.
Treatment of HIV in children and adolescents
Treatment of HIV in children and adolescents follows the same premise as the approach in adults, to keep the virus at bay and prevent ancillary infections from occurring. Antiretrovirals (ART) stop the virus from multiplying, and when given together with other drugs, the general therapy is called HAART.
We will not focus on the particularities of these chemical agents, as it is enough for us to know that the prognosis of the treated children is excellent. Most children with HIV, if they receive adequate treatment, reach adulthood without problems. HAART reduces viral loads in the body to minimal expressions, so the virus poses no danger.
However, if the child is weak from the infection before starting regular treatment, preventive antibiotics or antifungal drugs may also be prescribed. An example of this is trimethoprim-sulfamethoxazole, which is used to prevent infection with pneumocystisa very dangerous bacterium for children.
HIV and vaccination
Because your child will be more susceptible to certain infections throughout their lives (even if they are on antiretrovirals), pediatricians recommend that young patients undergo a specialized vaccination program.
For example, pneumococcal vaccination, including 13-valent conjugate vaccine (NCV13), is recommended for all HIV-infected children aged 2 months to 18 years of age. Also It is recommended human papillomavirus (HPV) and flu vaccine every year.
However, children with severe immune deficiency should not receive certain vaccines, such as the MMR which immunizes against measles, rubella and mumps. This consists of live attenuated microorganisms, so the chances of something going wrong are high.
final notes
HIV in children and adolescents is no more serious than that in adults, provided treatment is started as soon as the disease is detected and followed to the letter. If so, the prognosis for those infected is excellent, regardless of their age.
On the other hand, it should also be noted that administering ART to infected pregnant mothers significantly reduces the chances of infecting the fetus. Therefore, a timely blood test and preventive medications can save the newborn from suffering a lifelong chronic condition.
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