According to a UNAIDS update, around 1.8 million children under the age of 15 years were affected by the human immunodeficiency virus (HIV) in the year 2017. Their report also shows that there has been a decline in new HIV infections among children by 8% since 2016 (1).
Even the thought of a child having HIV can be scary. And as a parent, you would want to know more about HIV in children, how it can affect them, and how you can protect your child from it. In this MomJunction post, we tell you about the causes of HIV, its symptoms, treatments, and preventive measures.
What Is HIV?
HIV is a virus that causes a condition called acquired immune deficiency syndrome or AIDS. The virus attacks the immune system, especially the CD4 cells, also known as white blood cells or T-cells that are an important part of the immune system. After infecting a person, the virus slowly destroys the body’s ability to fight infections.
How Do Children Acquire HIV?
Children can acquire HIV from the mother who has the infection, while they are in the womb or when they breastfeed (mother-to-child transmission). The virus can also transmit through the following:
- Blood transfusion, when an infected person’s blood is given to an otherwise healthy person
- Use of contaminated syringes at hospitals or for scarification (explained below)
- Sexual abuse, such as forced sexual interaction involving penetration
- Sexual intercourse (especially among adolescents). An HIV infected person can transmit the virus to the partner.
- Scarification (scratching or scraping of skin for a permanent modification of the body such as tattooing and piercing), for which an infected needle is used (2)
Note that HIV cannot spread via:
- Sharing utensils, food, or clothes
Knowing about the symptoms of this infection will help you seek medical intervention in time.
What Are The Symptoms Of HIV In Children?
The symptoms of HIV are similar to those of a common viral infection. They can be classified into mild, moderate, and severe, as explained in the table below (3):
|Swelling of the parotid gland (the salivary gland in the front of the ears)||Oral thrush lasting for more than two months||Yeast infection in the digestive tract or lungs|
|Swollen lymph nodes||Pneumonitis: It is associated with swelling and inflammation of the lung tissues||Serious bacterial infections such as blood infection, meningitis, or pneumonia, in two years|
|Recurring or constant ear infections||Persistent fever that lasts more than one month||Malignant lesions or tumors|
|Dermatitis – causes itchy rashes on the skin||Hepatitis – inflammation of the liver caused by an infection||Pneumocystis jiroveci pneumonia (most commonly occurring pneumonia with HIV)|
|Recurring or constant sinus infections||Recurring or constant diarrhea||Encephalopathy: inflammation of the brain|
|Increased spleen and liver (Hepatomegaly) size, causing abdominal swelling (4)||Complicated chickenpox|
Other symptoms that may indicate possible HIV infection include (5):
- Neurological dysfunction such as microcephaly (the head is smaller than normal), neurological impairment, hypertonia (decreased muscle tone causing rigidity in flexing and moving), delay in achieving developmental milestones, or mental confusion.
- Painful rashes with blisters on chest and back.
If a child with HIV develops AIDS, then he/she may show the following symptoms (6):
- Weight loss or difficulty in gaining weight
- Persistent rashes
- Swollen lymph nodes (a part of the immune system, which filters bacteria and viruses) (7)
- Chronic thrush (fungal infection of the mouth, skin, and fingernails) (8)
- Chronic diarrhea
- Prolonged fever
- Lack of energy
- Pelvic inflammatory disease
- Unusual infections
- Short-term memory loss
How Is HIV Diagnosed In Children?
HIV antibody testing is done in children aged 18 months and above, who may show signs of HIV infection (5). The testing is usually done in two steps: a screening enzyme-linked immunosorbent assay (EIA) followed by the Western blot test for confirming the HIV antibody (9).
The EIA test involves testing of blood samples or oral fluid collected from the gums and cheeks of the patients to determine the HIV antibodies. The Western Blot test also involves blood testing by separating the blood proteins and identifying the protein that indicates HIV infection.
Both the tests must yield positive results to confirm the diagnosis. If the child gets exposed to HIV through other sources (such as infected needles or syringes, sexual abuse) and shows the symptoms, but the test results are negative, then the test must be repeated later.
Treatment must begin soon enough if the diagnosis confirms HIV infection.
How Is HIV Treated In Children?
Children with an HIV infection should get the treatment as early as possible. The treatment involves the administration of antiretroviral drugs, which can slow down the rate at which HIV weakens the immune system. The drug is available in the form of syrup for children, although they may not always be practical considering that they must be taken in large quantities and have to be always refrigerated owing to their short shelf lives, (2).
The antiretroviral drugs given to pregnant women in early pregnancy have been found to greatly reduce the chance of HIV infection in the infant (3).
Children below the age of 15 years can also get benefited by the administration of an antibiotic called co-trimoxazole, which can prevent childhood infections. It has been found to reduce the mortality rate in children with HIV by more than 40%.
Can Children With HIV Receive Routine Immunizations?
Yes. Immunization can prevent diseases in children with HIV infection, although their response to the vaccination may vary depending on their body’s immunity level. The WHO has come up with the below chart of immunizations that children with an asymptomatic or symptomatic HIV can or cannot take (10).
|Vaccine||Asymptomatic HIV infection||Symptomatic HIV infection|
In any case, it is best to consult the pediatrician before going ahead with any vaccination schedule for the child with HIV.
How To Prevent HIV In Children?
The infection has almost been eliminated in high-income countries thanks to timely prevention, testing, and treatment options. However, the situation is still grim in sub-Saharan
Africa and South Asian countries (2). Here are some measures to prevent HIV in children:
- The best way to prevent HIV in kids is to prevent mother-to-child transmission. The administration of antiretroviral drugs at the initial stage of pregnancy can help preserve the immunity, promote growth and development, and increase the life span. Also, children who acquired the infection perinatally and received drug therapy showed 80% or higher increase in the survival rate (2).
- If the mother is HIV positive when she is pregnant, the delivery is done through a c-section to prevent the baby from contracting the virus through the birthing canal.
- Such mothers must not breastfeed the baby and use alternatives instead (3).
- If the child wants to get a tattoo or piercing done, then make sure to contact a professional who follows all the safety guidelines with the equipment used for the procedure (6). Ideally, children under the age of 18 should avoid getting tattoos, although some parents might want to get the child’s ears or nose pierced.
- When your child is due to get a vaccination or an injection for any reason, ensure that the medical professional is using fresh and unused syringes to prevent transmission of infections.
Next, we answer some more commonly asked questions about HIV in children.
Frequently Asked Questions:
1. How long are children with HIV likely to survive?
Sadly, around 25-30% of children succumb to the infection before the age of one if not treated in time; 50-60% of children who develop HIV symptoms early in life, but don’t get diagnosed or treated in time, die by the age of two (2). However, in children, who are given the antiretroviral drugs early on, the mortality rate was found to be reduced by fivefold or more.
In high-income countries, more than 80% of children with HIV live beyond six years.
2. How does HIV affect the growth and development of a child?
Studies show that HIV infection in children can retard physical and mental development. HIV positive children are found to have neurological problems, cognitive development stagnation, learning difficulties, and speech and language problems. Also, the virus can have a physiological effect, wherein the child has difficulty in gaining weight.
That said, the child may not necessarily show a delay in both cognitive and motor development. They can also have only one developmental delay, and it may appear early or by the age of two (11).
HIV can make a child vulnerable to various illnesses. However, it can be controlled through preventive measures and by ensuring the child is not exposed to unhygienic practices in hospitals or elsewhere. Also, timely treatment can help prolong the child’s life.
Do you have any experience to share with us? Let us know in the comment section below.
2. HIV in children; WHO
3. AIDS/HIV in Children; Stanford Children’s Health
4. Enlarged Liver; Cleveland Clinic
5. Diagnosis of HIV infection in infants and children; NCBI
6. HIV and AIDS; KidsHealth
7. Swollen lymph glands; Raising Children Network
8. Thrush and Other Candida Infections; American Academy of Pediatrics
9. Preventing and Managing HIV Infection in Infants, Children, and Adolescents in the United States; American Academy of Pediatrics
10. Immunizations for Children with HIV/AIDS; Baylor International Pediatrics AIDS Initiative
11. The Effect of HIV on Developmental Milestones in Children; Journal of AIDS & Clinical Research Search; OMICS International