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Since the initial description of acquired immune deficiency syndrome (AIDS) cases in infants and children more than 25 years ago, the epidemiology of the pediatric human immunodeficiency virus type 1 (HIV-1) epidemic has changed significantly. Most pediatric HIV infections occur through perinatal transmission. Dramatic declines in the number of perinatally HIV infected children have been reported in the USA and Europe due to prompt implementation of strategies to prevent mother-to-child transmission of HIV (PMTCT). Further, availability of highly active antiretroviral therapy (HAART) has led to improved survival of HIV-infected children into adolescence and adulthood, changing most HIV infections into a chronic rather than an acute disease. In contrast, prevention of mother-to-child HIV transmission is a major public health challenge in many resource-limited countries. Although several effective, simple, and less expensive prophylactic antiretroviral regimens are available to prevent perinatal HIV transmission, these interventions have not been widely implemented in the developing world.
Pediatricians and obstetricians play a crucial role in the prevention of perinatal HIV transmission, including identification of HIV-infected women during pregnancy, treatment of the pregnant women with appropriate antiretroviral therapy, ensuring evaluation for HIV infection in early infancy, and subsequent provision of ongoing care for children and families affected by HIV. The purpose of this chapter is to review advances in the prevention of perinatal HIV transmission and highlight certain unique features of HIV infection in infants with a focus on early diagnosis, clinical manifestations, treatment, and prognosis.
The acquired immunodeficiency syndrome (AIDS), first described in adult male homosexuals in the USA in 1981, is one manifestation of infection with the human immunodeficiency virus (HIV). HIV infection produces a wide range of clinical manifestations from asymptomatic infection to marked immunodeficiency. The four recognized routes of virus transmission are sexual contact with an HIV-infected individual; receipt of HIV-infected blood or blood products; parenteral exposure to HIV-contaminated equipment, and vertical transmission from an HIV-infected pregnant woman. The HIV pandemic has had a formidable impact on global maternal and child health and survival, with important public health consequences. As of December 2000, the World Health Organization (WHO) estimated that there are over 16 million women and 1.4 million children with HIV/AIDS worldwide. In the USA, over 400,000 cases of AIDS had been reported by June 2000. HIV-1 infection has become one of the leading causes of morbidity and mortality in children worldwide. In the USA, HIV infection was the seventh leading cause of death in children 1–4 years of age in 1996. The most common AIDS-defining conditions in children are listed in Table 18.1.
Descriptions of cases of AIDS in children began in 1982; almost 9000 cases of AIDS in individuals under 13 years of age had been reported in the USA by June 2000. Children under 13 years of age account for 1.2% of the total AIDS cases reported in the USA.
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