Impact of HIV on Infants and Children
- Through December 2002 over 7529 children with AIDS have been reported to CDC
- 91% of cases are the result of vertical transmission Pneumocystis carinii pneumonia toxoplasmosis
- Childhood AIDS comprises 1.2% of the cases in the USA opportunistic infections
Impact on Infants and Children
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Disproportionate impact on minority children
- "Approximately 85% of children are Black or Hispanic compared to approximately 53% of infected adults
- "Impact on children who are already impoverished and who often lack access to health care
Impact of on Infants and Children
- 30,000 children have lost a parent
- Prevalence infection among drug users in some inner city
communities is 50%
- 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.
- 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 on Adolescents and Young Adults
- Overall seroprevalence is 0.34 per 1000. High prevalence areas include Washington, DC, (5.3), Baltimore (2.1) and New York City
- At present, the largest single transmission category among adolescents is transfusion associated (36%)
- Second is homosexual behavior (25%)
- Heterosexual contact accounts for 13%
- Intravenous drug use accounts for 13%
Impact of on Adolescents and Young Adults
-
Adolescents are more similar to adults in their clinical presentation
- "PCP is the leading diagnosis (33%)
- "Candida esophagitis accounts for 12%
- "Cryptococcosis accounts for 9%
- "Chronic herpes simplex infection accounts for 7.6%
- "Leading non-infectious event is "wasting syndrome" (18%)
Global Impact
-
21.8 million people are infected with
- "Women comprise 42%
- "830,000 are infants and children
- Projected to be 60-70 million adults infected by end of year 2000
- Over 9 million children under age 15 have lost their mother to
Transmission in Developing Countries
- In adults, both men and women, heterosexual transmission accounts for 75% of infections
- In infants and children transmission occurs by vertical transmission and breast feeding
Blood Product Transmission
- 8% of patients with congenital anemia or cancer transfused between 1978-1984 became positive.
- 70-80% of Factor VIII and 40-50% of Factor IX recipients became positive
- 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
- 3 million people per year receive blood products in the USA, collected from 18 million donations
- Blood screening went into effect in March, 1985
- In 1995 6% of newly described cases were blood product related, compared to 19% in 1985
- Overall estimated risk in USA in 1991 is estimated at 1 in 225,000 per unit transfused
- Screening of blood products is still only 55% in developing countries
Additional Strategies For Prevention of Blood Product Transmission
- Donor screening, education and exclusion
- Autologous Blood
- Not using directed donations
- Virus inactivation treatment of plasma products
Casual Transmission in Children
- This is exceedingly uncommon and not a source of major concern
-
There have been 6 reported cases to date
- "One appears to be due to biting
- "Five were related to exposure to blood or body fluid exposures
Important Issues in Vertical Transmission
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Not all infants who are born to infected mothers will be infected
- "Approximately 25% infants will be positive (in the absence of AZT)
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"Mechanism of transmission of infection to the fetus or infant
- During pregnancy (approx 30%)
- During labor and delivery (approx 70%)
- By breast feeding (especially in developing countries)
Factors Associated with Infection in Infants
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Virus amount - how much is present
- "Varies with the state of the mother's health
- Virus phenotype - how virulent or "infectious"
- Immune protection by mother: antibody or cytotoxic T cells
- Genetics: CD4 and chemokine co-receptors (CCR4 & 5) -- how susceptible are cells to infection
- Other co-infections - disturbance of physical barriers