Symptoms of HIV infection and AIDS in children

The incubation period of HIV infection 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 for HIV is a relative term, since every 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).

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Common symptoms of HIV infection

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". In the blood of such patients, they display quite pronounced lymphopenia. The total duration of this syndrome is 2-4 weeks, followed by a latent period that lasts for many years. In the other half of the patients, there is no primary manifestation of the disease by the type of "mononucleosis syndrome", but nevertheless, at some stage of the latent period, separate clinical symptoms of HIV / AIDS appear. Especially characteristic increase in the posterior cervical, supraclavicular, elbow and axillary groups of lymph nodes.

Suspicion of HIV infection should be considered an increase in more than one lymph node in more than one group (except inguinal), lasting more than 1.5 months. The enlarged lymph nodes at palpation are painful, mobile, not soldered with subcutaneous tissue. From other clinical symptoms in this period of the disease unmotivated subfebrile condition, increased fatigue and sweating are possible. In peripheral blood in such patients, leukopenia, unstable reduction of T4-lymphocytes, thrombocytopenia, antibodies to HIV are constantly present.

This stage of HIV is referred to as a syndrome of chronic lymphadenopathy , since it manifests itself mainly in an intermittent, indefinitely prolonged enlargement of the lymph nodes. While it is not clear, with what frequency and in what specific terms the disease passes into the next stage - pre-AIDS. In this stage of HIV infection, the patient is concerned not only with enlarged lymph nodes, but also with fever, sweating, especially at night and even at normal body temperature. There are often diarrhea and weight loss. Repeated ARVI, recurrent bronchitis, otitis, pneumonia are very typical. On the skin are possible elements of simple herpes or fungal lesions, pustular eruptions, often there are persistent candidiasis stomatitis and esophagitis.

With further progression of the disease, the clinical picture of AIDS itself develops , which is manifested mainly by severe opportunistic infections and various neoplasms.

In peripheral blood, HIV infection is associated with leukopenia, lymphopenia, thrombocytopenia, anemia and increased ESR.

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Symptoms of HIV infection in children

Symptoms of HIV infection in children are determined by the stage of ontogenesis, which was the entry of HIV into the body (in utero or after birth) and the age of the child in the case of postnatal infection.

Congenital HIV infection manifests itself in characteristic syndromes. Clinical criteria for diagnosis of congenital HIV infection are: growth retardation (75%), microcephaly (50%), protruding frontal part resembling a box (75%), nose flattening (70%), mild strabismus (65%), elongated ocular gaps and blue sclera (60%), significant shortening of the nose (6S%).

When a child is infected in the perinatal period or after birth, the stages of the course of HIV infection do not differ from adults, but they have their own peculiarities.

The most common signs of both congenital and acquired HIV infection in children are persistent generalized lymphadenopathy, hepatosplenomegaly, weight loss, fever, diarrhea, delayed psychomotor development, thrombocytopenia with hemorrhagic manifestations, and pyemia.

Immunodeficiency increases the susceptibility of the child's organism to distinguishable infections and aggravates their course. Children are more likely to suffer ARVI, severe infernal infections with a tendency to a protracted, recurrent course and generalization. HIV-infected children often have disseminated cytomegalovirus infection, herpetic infection, toxoplasmosis, candidiasis lesions of the skin and mucous membranes. Less common is cobacteriosis, cryptoslidiosis, cryptococcosis.

HIV infection in children born to HIV-infected mothers

Vertical transmission of HIV from mother to child can occur during pregnancy, childbirth and breastfeeding.

Children infected with HIV in utero are often born prematurely, with signs of intrauterine malnutrition and various neurological disorders. In the postnatal period, such children develop poorly, suffer from recurrent infections, they have persistent generalized lymphadenopathy (especially the increase in axillary and inguinal lymph nodes), hepato- and splenomegaly.

The first signs of the disease often are persistent candidiasis of the oral cavity, stunted growth, violations of weight gain, lag in psychomotor development. Laboratory tests show leukopenia, anemia, thrombocytopenia, increased transaminases, hypergammaglobulinemia.

Approximately 30% of children infected with HIV from mothers develop rapidly. The condition is aggravated by late stages of HIV infection in the mother, a high viral load in the mother and baby in the first 3 months of life (HIV RNA> 100,000 copies / ml of plasma), low CD4 + lymphocyte counts, and early infection of the fetus.

With the progression of HIV infection in infants, the incidence of various infectious diseases such as acute respiratory viral infection, pneumonia, acute intestinal infections, etc., often increases. Lymphoid interstitial pneumonia, recurrent bacterial infections, candidal esophagitis, candidiasis of the lungs, HIV-encephalopathy, cytomegalovirus disease, atypical mycobacteriosis, severe herpetic infection, cryptosporidiosis.

The most common opportunistic infection in children of the first year of life who did not receive chemoprevention is pneumocystis pneumonia (7-20%).

An adverse prognostic factor of HIV is the delay in speech development, especially with receptive and expressive language disorders.

Stage of AIDS AIDS

In the AIDS stage, more than half of the children develop severe, often recurrent infections caused by Haemophilus influenzae, Streptococcus pneumoniae. Salmonella.

Oncological diseases are extremely rare in HIV-infected children.

CNS lesion is a constant syndrome of HIV infection in children. At the beginning of the disease, asteno-neurotic and cerebro-asthenic syndromes are noted. For the AIDS stage, HIV-encephalopathies and HIV-encephalitis are characteristic.

A significant difference in HIV infection in children is the development of lymphocytic interstitial pneumonia (LIP), combined with hyperplasia of pulmonary lymph nodes, which is often aggravated by the occurrence of pneumocystis pneumonia (PCP).

The development of pneumocystis pneumonia corresponds to the progression of the immunodeficiency state. With severe immunosuppression (CD4 + less than 15%), pneumocystis pneumonia is detected in 25% of patients. Due to primary and secondary prevention, as well as combined antiretroviral therapy, the number of children with pneumocystis pneumonia has decreased in recent years.

As a rule, pneumocyte pneumonia occurs in children no earlier than 3 months of age. The acute onset of the disease is extremely rare and is characterized by the appearance of fever, cough, dyspnoea, tachypnea. In most cases, the characteristic symptoms develop gradually. The child has progressive weakness, decreased appetite, pale skin, cyanosis of the nasolabial triangle. The body temperature at the onset of the disease can be normal or subfebrile. Cough also is not a characteristic sign of pneumocystis pneumonia and is detected in about 50% of patients. Initially, there is an obsessive cough, then the cough becomes pertussis, especially at night. Dyspnoea is noted in all children with pneumocystis stinging. With the progression of pneumocystis pneumonia, cardiopulmonary insufficiency may occur. An x-ray picture of pneumocystis pneumonia in the form of reduced transparency of the lungs, the appearance of symmetrical shadows in the form of butterfly wings, and "cotton lungs" is defined only in 30% of patients.

The diagnosis of pneumocystis pneumonia is based on the detection of a causative agent in sputum, in a material obtained with bronchoalveolar lavage or lung biopsy. In most HIV-infected children, pneumocystis pneumonia is associated with other opportunistic diseases.

For the prevention and treatment of pneumocystis pneumonia, sulfamethoxazole + trimethoprim is used. Pneumocystisnoe pneumonia prevention is administered to all children born to HIV-infected women from the age of 6 weeks to 6 months with the exclusion of HIV infection. Prevention of HIV in children with HIV infection is for life.

Lymphoid interstitial pneumonia is currently diagnosed in no more than 15% of HIV-infected children, and in most cases it is diagnosed in children with perinatal HIV infection. The emergence of lymphocytic inertial pneumonia is often associated with a primary contact with the Epstein-Barr virus and manifests itself against the background of severe clinical manifestations of HIV-generalized lymphadenopathy, hepatosplenomegaly, and enlargement of the salivary glands. The manifestation of lymphocytic interstitial pneumonia in such patients is the appearance of an unproductive cough, progressive dyspnea. Fever is noted in 30% of cases. The auscultative picture is scant. Sometimes rales are heard over the lower parts of the lungs. X-ray revealed two-sided lower-lobar (more often interstitial, less often reticulomodular) infiltrates. The roots of the lungs are broadened, not structural. Pulmonary pattern, as a rule, is not differentiated. In some patients, despite the radiographic changes in the lungs, for many years there may be no clinical manifestations of the disease.

Against the background of lymphocytic interstitial pneumonia, the development of bacterial pneumonia is possible, most often caused by Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae, which leads to an exacerbation of the clinical picture of pneumonia. Against the background of exacerbation, patients may develop airway obstruction, bronchiectasis, chronic pulmonary insufficiency.

Thus, the specific features of HIV infection in children include bacterial infections of the bronchi and lungs, against which the typical for HIV / AIDS patients develop viral, protozoal, fungal and mycobacterial diseases that determine the severity of the course and the outcome of the disease.

The appointment of combined antiretroviral therapy helps prevent the development of respiratory diseases in HIV-infected patients and significantly increases the effectiveness of their treatment.

According to the report of WHO experts (1988), the most characteristic AIDS-associated diseases of children besides lymphocytic interstitial pneumonia and pneumocystis pneumonia are: cytomegalovirus, herpetic infection, toxoplasmosis of the brain. Children rarely develop Kaposi's sarcoma.

Often there is anemia and thrombocytopenia, a clinically manifested hemorrhagic syndrome.

HIV infection in children born to HIV-infected women, especially with intrauterine infection, is more rapidly progressing compared to adults and children who have contracted other ways in their first year of life. In children infected at the age of more than one year, the course of the disease is more prognostically favorable compared to adults.

The above-described features of the course of HIV infection refer mainly to newborns and children of the first year of life, to a lesser extent to the age group up to 5 years. In children older than 5 years, these features are largely smoothed out. Adolescents over 12 years of age according to the nature of the disease can be referred to adults.