Opportunistic Infections in HIV Infected Infants and Children

Impact of HIV on Infants and Children

1. Through December 2002 over 7529 children with AIDS have been reported to CDC
2. 91% of cases are the result of vertical transmission Pneumocystis carinii pneumonia toxoplasmosis
3. Childhood AIDS comprises 1.2% of the cases in the USA opportunistic infections

Impact on Infants and Children

1. Disproportionate impact on minority children
   1. "Approximately 85% of children are Black or Hispanic compared to approximately 53% of infected adults
   2. "Impact on children who are already impoverished and who often lack access to health care

Impact of on Infants and Children

1. 30,000 children have lost a parent
2. Prevalence infection among drug users in some inner city communities is 50%

1. Currently the 6th leading cause of death in children between 1-4 years of age. In cities like Newark and New York, is already the first or second leading cause of death in Black or Hispanic children between 1-4 years of age.
2. is the leading cause of death among African-American women ages 25-44 in the USA and the 3rd leading cause of death of American women in this age group

Impact of on Adolescents and Young Adults

1. Adolescents are more similar to adults in their clinical presentation
   1. "PCP is the leading diagnosis (33%)
   2. "Candida esophagitis accounts for 12%
   3. "Cryptococcosis accounts for 9%
   4. "Chronic herpes simplex infection accounts for 7.6%
   5. "Leading non-infectious event is "wasting syndrome" (18%)

Global I21.8 million people are infected with

1. "Women comprise 42%
2. "830,000 are infants and children

1. Projected to be 60-70 million adults infected by end of year 2000
2. Over 9 million children under age 15 have lost their mother to

Transmission in Developing Countries

1. In adults, both men and women, heterosexual transmission accounts for 75% of infections
2. In infants and children transmission occurs by vertical transmission and breast feeding

Blood Product Transmission

1. 8% of patients with congenital anemia or cancer transfused between 1978-1984 became positive.
2. 70-80% of Factor VIII and 40-50% of Factor IX recipients became positive
3. The clinical latency period is approximately 41 months in children. The clinical latency is longer in children compared to adolescents and adults

Blood Product Transmission

1. 3 million people per year receive blood products in the USA, collected from 18 million donations
2. Blood screening went into effect in March, 1985
3. In 1995 6% of newly described cases were blood product related, compared to 19% in 1985
4. Overall estimated risk in USA in 1991 is estimated at 1 in 225,000 per unit transfused
5. Screening of blood products is still only 55% in developing countries

Additional Strategies For Prevention of Blood Product Transmission

1. Donor screening, education and exclusion
2. Autologous Blood
3. Not using directed donations
4. Virus inactivation treatment of plasma products

Casual Transmission in Children

1. This is exceedingly uncommon and not a source of major concern
2. There have been 6 reported cases to date
   1. "One appears to be due to biting
   2. "Five were related to exposure to blood or body fluid exposures

Important Issues in Vertical Transmission

1. Not all infants who are born to infected mothers will be infected
   1. "Approximately 25% infants will be positive (in the absence of AZT)
   2. "Mechanism of transmission of infection to the fetus or infant
      1. During pregnancy (approx 30%)
      2. During labor and delivery (approx 70%)
      3. By breast feeding (especially in developing countries)

Factors Associated with Infection in Infants

1. Virus amount - how much is present
   1. "Varies with the state of the mother's health
2. Virus phenotype - how virulent or "infectious"
3. Immune protection by mother: antibody or cytotoxic T cells
4. Genetics: CD4 and chemokine co-receptors (CCR4 & 5) -- how susceptible are cells to infection
5. Other co-infections - disturbance of physical barriers
6.