children and babies with HIV/AIDS.
Introduction
As is discussed in our lesson focusing on HIV and pregnancy, we have made tremendous progress in terms of reducing the risk of HIV-positive pregnant women giving birth to babies who are also infected with the virus. Provided that an HIV-positive woman takes good care of herself and her developing baby—which includes getting proper prenatal care and beginning a drug regimen that contains Retrovir (zidovudine)—the risk of HIV transmission is less than 2 percent. Good news, indeed, for all HIV-positive women who are pregnant…or hope to become pregnant.
This good news, however, means very little to the estimated 10,000-plus children in the United States who are already infected with the virus. But to be an HIV-positive child is not nearly as dire as it once was. As we have been seeing with adults infected with the virus, controlling HIV in young patients has dramatically improved in recent years. Approximately a decade ago, a pediatric HIV diagnosis was associated with a dismal prognosis: most infected children would die before their fifth birthday. Today, thanks to early access to care and advances in HIV drug treatment, approximately half of all HIV-infected children will live to enter—and graduate—from high school and beyond. And with more information quickly emerging with respect to how HIV-infected children should be treated, we can expect the success rate to improve significantly.
This lesson focuses specifically on the special needs of children living with HIV. Here, you will learn some basic information about HIV infection in children, including the differences between HIV in children and adults and specific treatments available for HIV-positive children.
Caring for a child who is HIV positive comes with many challenges. We sincerely hope that this lesson will provide readers with the necessary information, not only to better understand children and HIV, but also to enhance communication with pediatric health care providers.
Children & HIV Infection: The Basics
Contrary to popular opinion, children are not simply little adults. HIV, even during the earliest stages of infection, can severely affect a child's development, whether related to physical growth, psychological evolvement, or emotional well being.
Children have different immune systems than adults. HIV rapidly impairs a child's immune system ability to control common childhood infections, such as bacterial-associated lung and ear infections and viral infections like chicken pox. HIV also prevents the immune system from producing memory cells which, in adults, help ward off life-threatening infections like Pneumocystis pneumonia (PCP), Mycobacterium avium complex (MAC), and cytomegalovirus (CMV). What's more, many HIV-infected children are born to mothers who abused alcohol and/or drugs while pregnant, which can worsen problems caused by HIV infection.
Researchers have shown that HIV-infected babies tend to have higher viral loads than adults, which can sometimes reach millions of HIV-RNA copies in a single milliliter of blood. As a result, the lessons we have learned treating adults with HIV hold true for children infected with the virus: a powerful combination of drugs should be used to lower a child's viral load to the lowest possible level.
Treating Children with HIV
The United States Department of Health and Human Services (DHHS)—a branch of the federal government that oversees health care policy in the United States—has published guidelines focusing on how best to treat HIV-infected children. These guidelines are important, as they help to make sure that all HIV-infected children in the United States are sufficiently cared for and treated.
The guidelines, which were updated in March 2009, are based on data collected from a number of studies—along with expert opinions—focusing on the importance of treating HIV-positive children, including the best time to start treatment and the best treatments to use.
Once HIV treatment is started, the HIV-positive child will need to be monitored regularly to make sure that the medications are working well and not causing any serious side effects. If a significant problem arises while on therapy—such as a viral load becoming and/or remaining detectable, suppression of the immune system, symptoms of infection, slowed development of the central nervous system or growth failure —a switch in therapy might be necessary.
Which meds can be used?
Many clinical trials have determined thatHIV drugs, particularly when used in combination with each other, work well and are safe in children. However, it is important to recognize that manyHIV drugs are absorbed, metabolized (broken down) and eliminated from the body differently in children than in adults. In turn, various research teams have spent the past decade trying to identify the correct dosages for each HIV drug for children infected with the virus. Fortunately, many of the drugs used to treat adults with HIV can also be used to treat children with HIV infection. In fact, many have also been found to be safe and effective for newborns and infants infected with the virus.
Next we'll look at all of the drugs approved to treat HIV infection. Included in these lists are the correct doses for children—which will depend either on size or body weight—along with information about the availability of liquid or powder formulations that can be used by children who are unable to swallow pills.
By clicking on the links for each drug, you will be taken to our drug summary pages. Here you can learn about the expected side effects for each, along with important information about medications that should not be taken at the same time as these drugs.
As is discussed in our lesson focusing on HIV and pregnancy, we have made tremendous progress in terms of reducing the risk of HIV-positive pregnant women giving birth to babies who are also infected with the virus. Provided that an HIV-positive woman takes good care of herself and her developing baby—which includes getting proper prenatal care and beginning a drug regimen that contains Retrovir (zidovudine)—the risk of HIV transmission is less than 2 percent. Good news, indeed, for all HIV-positive women who are pregnant…or hope to become pregnant.
This good news, however, means very little to the estimated 10,000-plus children in the United States who are already infected with the virus. But to be an HIV-positive child is not nearly as dire as it once was. As we have been seeing with adults infected with the virus, controlling HIV in young patients has dramatically improved in recent years. Approximately a decade ago, a pediatric HIV diagnosis was associated with a dismal prognosis: most infected children would die before their fifth birthday. Today, thanks to early access to care and advances in HIV drug treatment, approximately half of all HIV-infected children will live to enter—and graduate—from high school and beyond. And with more information quickly emerging with respect to how HIV-infected children should be treated, we can expect the success rate to improve significantly.
This lesson focuses specifically on the special needs of children living with HIV. Here, you will learn some basic information about HIV infection in children, including the differences between HIV in children and adults and specific treatments available for HIV-positive children.
Caring for a child who is HIV positive comes with many challenges. We sincerely hope that this lesson will provide readers with the necessary information, not only to better understand children and HIV, but also to enhance communication with pediatric health care providers.
Children & HIV Infection: The Basics
Contrary to popular opinion, children are not simply little adults. HIV, even during the earliest stages of infection, can severely affect a child's development, whether related to physical growth, psychological evolvement, or emotional well being.
Children have different immune systems than adults. HIV rapidly impairs a child's immune system ability to control common childhood infections, such as bacterial-associated lung and ear infections and viral infections like chicken pox. HIV also prevents the immune system from producing memory cells which, in adults, help ward off life-threatening infections like Pneumocystis pneumonia (PCP), Mycobacterium avium complex (MAC), and cytomegalovirus (CMV). What's more, many HIV-infected children are born to mothers who abused alcohol and/or drugs while pregnant, which can worsen problems caused by HIV infection.
Researchers have shown that HIV-infected babies tend to have higher viral loads than adults, which can sometimes reach millions of HIV-RNA copies in a single milliliter of blood. As a result, the lessons we have learned treating adults with HIV hold true for children infected with the virus: a powerful combination of drugs should be used to lower a child's viral load to the lowest possible level.
Treating Children with HIV
The United States Department of Health and Human Services (DHHS)—a branch of the federal government that oversees health care policy in the United States—has published guidelines focusing on how best to treat HIV-infected children. These guidelines are important, as they help to make sure that all HIV-infected children in the United States are sufficiently cared for and treated.
The guidelines, which were updated in March 2009, are based on data collected from a number of studies—along with expert opinions—focusing on the importance of treating HIV-positive children, including the best time to start treatment and the best treatments to use.
Once HIV treatment is started, the HIV-positive child will need to be monitored regularly to make sure that the medications are working well and not causing any serious side effects. If a significant problem arises while on therapy—such as a viral load becoming and/or remaining detectable, suppression of the immune system, symptoms of infection, slowed development of the central nervous system or growth failure —a switch in therapy might be necessary.
Which meds can be used?
Many clinical trials have determined thatHIV drugs, particularly when used in combination with each other, work well and are safe in children. However, it is important to recognize that manyHIV drugs are absorbed, metabolized (broken down) and eliminated from the body differently in children than in adults. In turn, various research teams have spent the past decade trying to identify the correct dosages for each HIV drug for children infected with the virus. Fortunately, many of the drugs used to treat adults with HIV can also be used to treat children with HIV infection. In fact, many have also been found to be safe and effective for newborns and infants infected with the virus.
Next we'll look at all of the drugs approved to treat HIV infection. Included in these lists are the correct doses for children—which will depend either on size or body weight—along with information about the availability of liquid or powder formulations that can be used by children who are unable to swallow pills.
By clicking on the links for each drug, you will be taken to our drug summary pages. Here you can learn about the expected side effects for each, along with important information about medications that should not be taken at the same time as these drugs.
Too many young people in the United States (US) are at risk for HIV infection. This risk is especially notable for young gay, bisexual, and other men who have sex with men (MSM) 1 , especially young African American or Latino MSM, and all youth of minority races and ethnicities. Continual HIV prevention outreach and education efforts, including programs on abstinence, delaying the initiation of sex, and negotiating safer sex, are required as new generations replace the generations that benefited from earlier prevention strategies. The Numbers New HIV Infections (Ages 13–29 Years)
- In 2009, young persons accounted for 39% of all new HIV infections in the US. For comparison's sake, persons aged 15–29 comprised 21% of the US population in 2010.
- Young MSM, especially those of minority races and ethnicities, are at increased risk for HIV infection. In 2009, young MSM accounted for 27% of new HIV infections in the US and 69% of new HIV infections among persons aged 13–29. Among young black MSM, new HIV infections increased 48% from 2006 through 2009.
- An estimated 8,294 young persons were diagnosed with HIV infection in 2009 in the 40 states with long-term HIV reporting, representing about 20% of the persons diagnosed during that year.
- Seventy-five percent (6,237) of these diagnoses occurred in young people aged 20–24 years. Indeed, those aged 20–24 had the highest number and rate of HIV diagnoses of any age group (36.9 new HIV diagnoses/100,000 people).
- In 2009, young blacks accounted for 65% (5,404) of diagnoses of HIV infection reported among persons aged 13–24 years.
- In 2008, an estimated 22% of persons aged 13–24 living with diagnosed HIV infection were infected through hemophilia, blood transfusion, birth, or unknown transmission mode, with the majority being infected perinatally.