Introduction

Most pediatric patients with HIV infection in rich countries live in major cities. However, cases have been reported in smaller cities and rural areas. Any clinician who sees sick children in an acute care setting may treat children with HIV and should be familiar with the atypical and sometimes life-threatening diseases that affect these children.

HIV-infected children average 1.2 visits to the emergency department (ED) and 15 ambulatory care visits per year [1]. Children who meet the case definition for pediatric AIDS average 2 ED visits and 18 ambulatory care visits each year [1]. HIV-infected children present to the ED with different complaints, are more likely to have diagnostic or therapeutic procedures performed and are more likely to be admitted to the hospital than uninfected children [2]. HIV status may not be known at the time of an ED visit. Manifestations of HIV infection may not be recognized [3, 4].

Much of the early improvement in HIV-related mortality was related not to new antiretroviral therapies, but to the prompt and effective treatment of the opportunistic infections associated with HIV disease. Even with the wide variety of antiretroviral therapies currently available, the quick recognition and aggressive treatment of the infectious complications of HIV infection in children may be life saving. Initial diagnosis of HIV infection may be made when a child presents with an acute and possibly life-threatening illness. Physicians must know the right questions to ask and the signs to look for.