By the end of 1993, 5,234 pediatric cases of Acquired Immune Deficiency Syndrome (AIDS) had been reported to the Centers for Disease Control, and the CDC estimates that within the next few years, 10,000 to 20,000 children will have AIDS. AIDS is particularly devastating in children because of its rapid progression. The average age of diagnosis for a child is nine months, and 50 percent die within a year if untreated. Still, physicians are identifying ways to lower the risk in children, and drugs used to slow the course of the disease in adults are proving increasingly effective in children, too.
WHAT CAUSES AIDS?
AIDS is caused by infection with the human immunodeficiency virus (HIV). Once in the body, HIV targets a type of white blood cell called T4 lymphocytes and injects its genetic material, instructing the T4 cell to become an HIV factory. The virus then reproduces itself until the T4 cell dies, spewing forth millions of new viruses as it does so. As the normally protective T4 cells are destroyed, the immune system is thrown off balance—deficient in vitally protective T4 cells while the other white blood cells (T8) responsible for suppressing the body's immune response remain intact. The imbalance between these white blood cell types impairs the immune system's ability to ward off and combat infections, and the symptoms of AIDS develops.
HOW COULD A CHILD CONTACT AIDS?
HIV enters the body through direct contact with certain body fluids, including blood, semen, vaginal secretions, and to a lesser extent, breast milk. For over 90 percent of pediatric AIDS patients, transmission of the virus is from an infected mother to the baby, either before or during birth. The mother may or may not have symptoms herself. A very few babies may contract the virus through mother's milk. Some cases are the result of sexual abuse.
Researchers are carefully exploring the way AIDS is passed from mother to child to identify intervention points. One study suggests that delivering HIV-positive women by cesarean section may prevent some cases of AIDS. Other studies have found that certain drugs given to HIV-positive pregnant women may block transmission to the fetus.
Before 1985, some cases of AIDS were contracted through blood transfusions. Since that time, very strict controls were begun on the supply of blood and blood products.
WHEN SHOULD PARENTS SUSPECT THEIR CHILD HAS AIDS?
A child born to a mother who is HIV positive faces a 30 percent chance of becoming infected before or during birth. If a mother does not know her HIV status, signs to watch for in her child include unusual infections, recurring infections, and severe, long-lasting effects from infections that are routine in other children—particularly infections of the lungs (pneumonia) and skin. Thrush, a common fungal infection in which whitish particles grow in the mouth, occurs persistently and severely in children with AIDS, as does diarrhea caused by parasites.
Also watch for developmental delays. Infection of the brain with HIV can prevent a baby from sitting, crawling, standing and walking when healthy children usually do. Verbal and motor skills are lost rather than gained. Newborns face a higher risk of meningitis, a serious infection of the lining of the brain.
WHEN SHOULD MEDICAL ATTENTION BE SOUGHT?
The possibility of AIDS should be raised when a parent has the disease or engages in high-risk behaviors such as IV drug use or unsafe sex practices. If you suspect your child is at risk or may have symptoms of AIDS, seek medical attention as soon as possible. Early intervention can slow the course of the disease.
INDICATIONS OF AIDS INCLUDE:
• Pneumocystis carinii pneumonia (PCP)
• Frequent and severe infections
• Frequent fevers and diarrhea
• Poor growth and weight gain
• Developmental regression
• Swollen lymph glands, spleen or salivary glands
HOW CAN THE DOCTOR TELL IF MY CHILD HAS AIDS?
Accurate diagnosis is complicated in a child because for as long as the first 15 months of life, he will harbor antibodies to HIV made by the mother and passed on before birth. A diagnostic AIDS test based on detecting those antibodies may therefore be positive for the first year or so even though the baby may not actually be infected with HIV. If a child is found to have HIV antibodies, more definite tests to detect the virus itself or some of its components may be employed to determine whether the infant has become infected. Such tests may be positive within the first few weeks or months of life.
WHAT TREATMENTS ARE AVAILABLE?
Doctors are armed with an ever-expanding arsenal of drugs to keep the infections of AIDS at bay. In the first months of life, antibiotic drugs may prevent pneumocystis carinii pneumonia (PCP)—an often-fatal AIDS-related infection—and other bacterial infections. Good nutrition and vaccines for the common childhood illnesses can prolong survival, and support from loved ones can greatly improve the quality of an affected child's life. Experimental vaccines, such as one under development for chicken pox, are being studied for children with AIDS, in whom such an illness may be quite severe. Repeated intravenous injections of gammaglobulin may be used to ward off infection.
Once symptoms arise drug treatment begins. AIDS treatments are evolving in the same direction as many cancer treatments, toward combinations of drugs that work against the virus and its effects in different ways. The Food and Drug Administration has approved the use of idovudine (also known as azidothymidine, or AZT) and dideoxyinosine (ddI) in children. AZT and ddI interfere with HIV's ability to replicate within human cells. Researchers are also engineering dozens of immune system chemicals to fight HIV. The National Institutes of Health fund medical-center programs to which HIV-infected children may be referred for the most up-to-date investigations and treatment.
