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 routes and nature of infection, the infecting dose, the age of the child and many other factors. In case of infection through blood transfusions, this period is short, and in case of sexual infection, it is longer. The duration of the incubation period for HIV is a relative concept, since each specific patient has different meanings for it. If we calculate the incubation period from the moment of infection to the appearance of the first signs of manifestation of opportunistic infections as a result of immune depression, then it averages about 2 years and can last more than 10 years (observation periods).

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Common symptoms of HIV infection

In fact, about half of those infected with HIV have an elevated body temperature 2-4 weeks after infection, this increase continues for up to 2 weeks, the lymph nodes, liver and spleen enlarge. Tonsillitis is often detected. The symptom complex that occurs in this case is called "mononucleosis-like syndrome". In the blood of such patients, fairly pronounced lymphopenia is detected. The total duration of this syndrome is 2-4 weeks, after which a latent period begins, lasting many years. The other half of patients do not have the primary manifestation of the disease as "mononucleosis syndrome", but still, at some stage of the latent period, they also develop individual clinical symptoms of HIV / AIDS. Especially characteristic is the enlargement of the posterior cervical, supraclavicular, elbow and axillary groups of lymph nodes.

Suspicious HIV infection should be considered an enlargement of more than one lymph node in more than one group (except inguinal), lasting more than 1.5 months. Enlarged lymph nodes are painful to palpation, mobile, not fused with subcutaneous tissue. Other clinical symptoms in this period of the disease may include unmotivated subfebrile temperature, increased fatigue and sweating. In the peripheral blood of such patients, leukopenia, an inconstant decrease in T4 lymphocytes, thrombocytopenia, and antibodies to HIV are constantly present.

This stage of HIV is called chronic lymphadenopathy syndrome, since it manifests itself mainly in intermittent, indefinitely long-term enlargement of the lymph nodes. It is still unclear how often and in what specific time frame the disease progresses to the next stage - pre-AIDS. At this stage of HIV infection, the patient is bothered not only by enlarged lymph nodes, but also by an increase in body temperature, sweating, especially at night and even at normal body temperature. Diarrhea and weight loss are common. Repeated acute respiratory viral infections, recurrent bronchitis, otitis, and pneumonia are very common. Elements of simple herpes or fungal lesions, pustular rashes are possible on the skin, persistent candidal stomatitis and esophagitis often occur.

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 with HIV infection, leukopenia, lymphopenia, thrombocytopenia, anemia and increased ESR are observed.

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Symptoms of HIV infection in children

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

Congenital HIV infection is characterized by characteristic syndromes. The clinical criteria for the diagnosis of congenital HIV infection are: growth retardation {75%), microcephaly (50%), prominent frontal part resembling a box in shape (75%), flattening of the nose (70%), moderate strabismus (65%), elongated palpebral fissures 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 HIV infection are no different from those in adults, but have their own characteristics.

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 body to distinguishable infections and aggravates their course. Children more often suffer from acute respiratory viral infections, severe infernal infections with a tendency to protracted, recurrent course and generalization. HIV-infected children often have disseminated cytomegalovirus infection, herpes infection, toxoplasmosis, candidal lesions of the skin and mucous membranes. Less common are cobacteriosis, cryptosloridiosis, cryptococnosis.

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 hypotrophy and various neurological disorders. In the postnatal period, such children develop poorly, suffer from recurrent infections, and are found to have persistent generalized lymphadenopathy (especially important is the enlargement of the axillary and inguinal lymph nodes), hepato- and splenomegaly.

The first signs of the disease are often persistent oral candidiasis, growth retardation, impaired weight gain, and delayed psychomotor development. Laboratory studies show leukopenia, anemia, thrombocytopenia, elevated transaminases, and hypergammaglobulinemia.

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

As HIV infection progresses in young children, the incidence of various infectious diseases increases many times over, such as acute respiratory viral infections, pneumonia, acute intestinal infections, etc. The most common are lymphoid interstitial pneumonia, recurrent bacterial infections, candidal esophagitis, pulmonary candidiasis, HIV encephalopathy, cytomegalovirus disease, atypical mycobacteriosis, severe herpes infection, and cryptosporidiosis.

The most common opportunistic infection in children aged 1 year who did not receive chemoprophylaxis is Pneumocystis pneumonia (7-20%).

An unfavorable prognostic factor for HIV is delayed speech development, especially with receptive and expressive language impairment.

AIDS stage of HIV infection

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

Oncological diseases are extremely rare in HIV-infected children.

CNS damage is a constant syndrome of HIV infection in children. At the onset of the disease, astheno-neurotic and cerebro-asthenic syndromes are observed. HIV encephalopathy and HIV encephalitis are characteristic of the AIDS stage.

A significant difference in HIV infection in children is the development of lymphocytic interstitial pneumonia (LIP), combined with hyperplasia of the 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+ count less than 15%), Pneumocystis pneumonia is detected in 25% of patients. Thanks 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, pneumocystis pneumonia occurs in children no earlier than 3 months of age. Acute onset of the disease is extremely rare and is characterized by fever, cough, dyspnea, tachypnea. In most cases, characteristic symptoms develop gradually. The child has progressive weakness, loss of appetite, pale skin, cyanosis of the nasolabial triangle. Body temperature at the onset of the disease may be normal or subfebrile. Cough is also not a characteristic sign of pneumocystis pneumonia and is detected in about 50% of patients. At first, an obsessive cough appears, then the cough becomes whooping cough-like, especially at night. All children with pneumocystis pneumonia have shortness of breath. With the progression of pneumocystis pneumonia, cardiopulmonary failure may occur. The radiological picture of pneumocystis pneumonia in the form of decreased transparency of the lungs, the appearance of symmetrical shadows in the form of butterfly wings, “cotton wool lungs” is determined only in 30% of patients.

The diagnosis of PCP is based on detection of the pathogen in sputum, bronchoalveolar lavage, or lung biopsy. In most HIV-infected children, PCP is combined with other olportunistic diseases.

For the prevention and treatment of pneumocystis pneumonia, sulfamethoxazole + trimethoprim is used. Prevention of pneumocystis pneumonia is carried out for all children born to HIV-infected women from the age of 6 weeks to 6 months, if the diagnosis of "HIV infection" is excluded. In children with HIV infection, prevention is carried out for life.

Lymphoid interstitial pneumonia is currently diagnosed in no more than 15% of HIV-infected children, and in most cases is detected in children with perinatal HIV infection. The occurrence of lymphocytic interstitial pneumonia is often associated with primary contact with the Epstein-Barr virus and manifests itself against the background of pronounced clinical manifestations of HIV-generalized lymphadenopathy, hepatosplenomegaly, and an increase in the salivary glands. The manifestation of lymphocytic interstitial pneumonia in such patients is the appearance of unproductive cough, progressive dyspnea. Fever is noted in 30% of cases. Auscultatory picture is scanty. Sometimes wheezing is heard over the lower parts of the lungs. Radiologically, bilateral lower lobe (usually interstitial, less often reticulomodular) infiltrates are detected. The roots of the lungs are dilated, non-structural. The pulmonary pattern is usually undifferentiated. Some patients, despite radiological changes in the lungs, may have no clinical manifestations of the disease for many years.

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

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

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

According to the WHO expert report (1988), the most typical AIDS-associated diseases in children, in addition to lymphocytic interstitial pneumonia and pneumocystis pneumonia, include: cytomegalovirus, herpes infection, and toxoplasmosis of the brain. Kaposi's sarcoma develops extremely rarely in children.

Anemia and thrombocytopenia are common, clinically manifested by hemorrhagic syndrome.

HIV infection in children born to HIV-infected women, especially in cases of intrauterine infection, is characterized by a more rapidly progressive course compared to adults and children infected in the first year of life by other routes. In children infected at the age of over one year, the course of the disease is more prognostically favorable compared to adults.

The above-described features of the course of HIV infection relate 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 over 5 years of age, these features are significantly smoothed out. Adolescents over 12 years of age, according to the nature of the course of the disease, can be classified as adults.