HIV infection and AIDS in children
Last reviewed: 23.04.2024
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HIV infection, AIDS is a viral disease of the immune system, leading to a sharp decrease in the overall resistance of the organism to opportunistic microorganisms, as well as an increased predisposition to oncological diseases, which is why the disease has a severe course with an unavoidable fatal outcome.
HIV infection is a long-term infectious disease caused by the human immunodeficiency virus (HIV), which affects cells of the immune, nervous and other systems and organs of man. With HIV infection, the immune system progresses, leading to the development of the acquired immunodeficiency syndrome (AIDS).
HIV infection was detected in 1981, when the Center for Disease Control and Prevention (CDC) reported 5 cases of pneumocystis pneumonia and 28 cases of Kaposi's sarcoma in previously healthy homosexuals. In immunological studies, these patients had a sharp decrease in CD4 lymphocyte count. For the first time, a diagnosis was made: Acquired Immunodeficiency Syndrome (AIDS), in the Russian translation - Acquired Immunodeficiency Syndrome (AIDS).
[Epidemiology of HIV infection in children
HIV infection is found on all continents and practically in all countries where a systematic search of patients is conducted. According to WHO, about 50 million people live with HIV. Every year more than 2 million people with HIV infection are identified.
The age structure of the diseased, and especially the infected, is not exactly established. According to generalized data, the share of children among the sick reaches 10% or more.
Causes of HIV infection in children
Exciter. The human immunodeficiency virus (HIV) belongs to the family of retroviruses (Retroviridae). In the family of retroviruses, two sub-families of Oncoviridae and slow lentiviruses are isolated. The first subfamily includes viruses that cause leukemia: T-cell leukemia and chronic hairy cell leukemia, as well as leukemia virus of cattle.
HIV belongs to the subfamily of lentiviruses. Currently, 7 species of lentiviruses are known, of which 6 are pathogenic for animals and only one (HIV) causes human disease.
Pathogenesis of HIV infection in children
Each type of virus affects a certain type of cells. The ability of the virus to penetrate the cell is determined by the presence of a receptor on the target cell for the given virus, as well as the possibility of the virus genome to integrate into the genome of the cell. It is known that the cell can have receptors for various types of viruses and receptors for a specific virus can be on cells of various types.
The receptor for HIV is the differentiating antigen CD4, as well as nonspecific, independent of the presence of CD4 components. CD4 is a glycoprotein with a molecular weight of 55,000, similar in structure to certain regions of immunoglobulins. A similar structure has the protein of the virus gp 120, which determines the ability of the penetration of HIV into the cell.
Symptoms of HIV infection in children
The incubation period is from 2 weeks to 2 months. The duration of the incubation period depends on the ways and nature of the infection, the infection dose, the age of the child and many other factors. When infected through blood transfusion, this period is short, and for sexually transmitted infections it is longer. The duration of the incubation period is a relative term, since every different patient has different content in it. If we calculate the incubation period from the moment of infection to the appearance of the first signs of the manifestation of opportunistic infections as a result of the depression of immunity, then it averages about 2 years and can last for more than 10 years (the observation period).
In fact, approximately half of those infected with HIV have a fever after 2-4 weeks from the moment of infection, this increase lasts up to 2 weeks, lymph nodes, liver and spleen increase. Quite often they find a sore throat. The resulting symptom complex is called a "mononucleoside-like syndrome".
Where does it hurt?
Classification of HIV infection in children
WHO recommends that four stages of the disease be distinguished:
- initial (acute);
- persistent generalized lymphadenopathy;
- AIDS-associated complex as pre-AIDS;
- unfolded AIDS.
In addition, recently offer to identify and the fifth stage of the disease - AIDS dementia.
Diagnosis of HIV infection in children
Most children born to HIV-infected mothers have antibodies to HIV in their blood (mothers). In this regard, serological methods of diagnosing HIV infection, based on the definition of IgG antibodies (ELISA), are not diagnostically significant up to 18 months of life, when the maternal antibodies are completely destroyed.
Own specific antibodies appear in the child in 90-95% of cases within 3 months after infection, in 5-9% - after 6 months and in 0,5% - later. In children older than 18 months, the detection of serological markers is considered diagnostic.
Planned serological tests are performed at birth, at 6; 12 and 18 months of life. Getting two or more negative results at intervals of at least 1 month in a child without hypogammaglobulinemia at the age of 12 months and older is indicative of HIV infection.
What do need to examine?
What tests are needed?
Who to contact?
Treatment of HIV infection in children
The purpose of therapy for HIV infection is to maximize the patient's life and preserve its quality. Life expectancy without treatment in children is less than 6 months in 30% of cases, 75% of children survive to 6 years of age and up to 9 years of age to 50%.
It is necessary to conduct complex strictly individualized therapy of patients with HIV infection, with careful selection of antiretroviral drugs, timely treatment of secondary diseases. The treatment plan is constructed taking into account the stage of the pathological process and the age of the patients.
Treatment is carried out in three directions:
- influence on the virus with the help of antiretroviral drugs (etio-tropic);
- chemoprophylaxis of opportunistic infections;
- treatment of secondary diseases.
Drugs
Prevention of HIV infection in children
The antiepidemic regimen for HIV infection is the same as for hepatitis B. In pediatrics, the system of preventive measures should be based on the fact that children usually become infected with HIV in high-risk families (AIDS patients, drug addicts, bisexuals, etc.). In this regard, the main preventive measure can be considered a worldwide struggle for a healthy lifestyle, as well as educational activities to combat prostitution, drug addiction, sexual perversion, etc.
Prognosis for HIV infection in children
Very heavy. At clinically expressed forms the lethality is about 50%. From diagnosis to death, from 2-3 months to 2 years and more. In no case, normal immune functions are restored spontaneously or under the influence of treatment. Among the patients diagnosed before 1982, about 90% have died so far. However, recently there have been reports of a more favorable prognosis, especially in the case of HIV infection of the second type. Patients with Kaposi's sarcoma have a better prognosis than patients with opportunistic infections. There is an opinion that patients with Kaposi's sarcoma have less damage to the immune system.
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