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What special needs do HIV positive children have?
Apr 29, 2004

Hi, We are considering international adoption. Several available children are HIV positive. What are the special needs of a child with HIV? What is the financial risk? The odds of ever being HIV negative? What are the risks to my biological children? Where can I read more about this?

Many thanks,

Response from Dr. Luzuriaga

It's unclear from your question how the children were diagnosed "HIV positive." Since mothers transmit antibodies to their babies during the last trimester of pregnancy, all full-term babies born to HIV positive women will be antibody positive. However, only about 30% of women transmit the virus to their infants in the absence of antiviral therapy (even fewer transmit if moms are on treatment). Most uninfected babies born to HIV positive moms clear antibodies from their blood by 18 months of age. So, if the children are over 18 months and are antibody positive, they are likely infected. If they are over 18 months and antibody negative, they are most likely uninfected. If they are under 18 months and are antibody positive, more specific testing (e.g., PCR to detect HIV nucleic acids) is necessary to determine the child's infection status.

While children generally develop symptoms of HIV infection more rapidly than adults, the course of HIV infection is highly variable and difficult to predict. However, we do know that starting antiretroviral therapy before children experience symptoms or a decline in their CD4 count can help to keep them well. If the child is already symptomatic, the degree to which they are reversible varies with the symptoms and their severity; neurological damage is often more difficult to reverse on therapy than other symptoms (swollen lymph nodes, thrush, certain infections, etc).

Transmission of the virus is extremely rare in family settings, so the risk to your biological children is low, particularly if you avoid situations which may involve contact with blood.

There is a lot of good information on this web site regarding pediatric HIV infection and treatment (see especially the "Treatment Guidelines" section). I would urge you to look it over. Your pediatrician should be able to review with you the medical records of specific children that you are thinking of adopting to help you understand what his/her special needs may be. I wish you the best of luck and please don't hesitate to write again if additional questions arise.

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