Pediatric HIV Infection(2)
- Based on case reports to Centers for Disease Control and Prevention (CDC) from 33 reporting areas, at least 1,956 children under 13 years are currently living with HIV infection that has not progressed to AIDS. Please note: Since HIV infection is not reported in all states, this number does not reflect all children with HIV infection in the United States.
- Two hundred sixty-two new cases of HIV infection that had not progressed to AIDS were reported from July 1998 through June 1999 in children under 13 years old (down from 295 in the previous 12-month period).
- Of these 262 newly reported pediatric HIV infection cases, the exposure categories were as follows: mother with/at risk for HIV infection (84%); hemophilia/coagulation disorder (2%); receipt of blood transfusion, blood components, or tissue (2%); and risk not reported or identified (13%).
- Of these 262 newly reported pediatric HIV infection cases,
- African-American - 169 (64.5%)
- Hispanic - 45 (17.2%)
- White - 44 (16.8%)
- Asian/Pacific Islander - 2 (0.8%)
- No new HIV cases in American Indians/Alaskan Natives were reported.(3)
- (Two children were reported whose race/ethnicity was unknown.)
- Of the 1,956 cumulative reported cases of children under 13 diagnosed with HIV infection that had not progressed to AIDS, through June 1999,
- African-American - 1,234 (63.1%)
- White - 456 (23.3%)
- Hispanic - 226 (11.6%)
- Asian/Pacific Islander or American Indian/Alaska Native - 22 (1.1%)
- (17 children were reported whose race/ethnicity was unknown.)
- 322 new cases of AIDS in children were reported from July 1998 through June 1999, a decline of about 17% over the last reporting year (slightly less than the 20% decline last year).
- Nearly all (92%, or 297 cases) pediatric AIDS cases diagnosed between July 1998 and June 1999 were reported as having a mother with or at risk for HIV infection. In seven percent (24) of the newly reported AIDS cases in children, there was no reported or identified risk, and in one case the exposure category was hemophilia/coagulation disorder.
- The HIV exposure categories for the 297 mothers, when known, were as follows: sex with a person with HIV infection (127, of which 42 were with an injecting drug user, 4 were with a bisexual male, 1 was with transfusion recipient with HIV infection, and 73 were with a person with HIV infection without specified risk); injecting drug use (75); mother received blood transfusion, blood components, or tissue (2), and 100 mothers with HIV infection for which the risk was not specified.
- Of the 322 new cases of AIDS in children under 13 years old in the twelve months prior to July 1999,
- African-American - 202 (62.7%)
- Hispanic - 80 (24.8%)
- White - 36 (11.2%)
- Asian/Pacific Islander or American Indian/Alaska Native - (0.6%)
- The four states reporting the largest numbers of new pediatric AIDS cases from July 1998 to June 1999 were: New York (81), Florida (49), New Jersey (27) and Pennsylvania (21).
- An estimated 3,669 of the 8,596 children with AIDS reported to CDC through June 1999 are currently living with AIDS.
- 6,672 AIDS cases have been reported in children under 5 years old; and 1,924 cases in ages 5 to 12.
- Reported cumulative AIDS cases in male children under 13 through June 1999 have been 4,428; cases in female children now total 4,168. (The main reason for the gender difference in children is that more boys were exposed to HIV due to hemophilia/coagulation disorder).
- In the 12 months from July 1998 to June 1999, there were no new cases of AIDS reported in children due to exposure to blood transfusion, blood components, or tissue.
- The distribution of cumulative reported AIDS cases (8,596) among male and female children under 13 years through June, 1999, by exposure categories is as follows:
- Mother with or at risk for HIV infection - 7,828 (91%)
- Receipt of blood transfusion, blood components, or tissue - 376 (4%)
- Hemophilia/coagulation disorder - 233 (3%)
- Risk not reported or identified - 159 (2%)
- Of the total number of 8,596 children with AIDS under the age of 13 who had been reported to the CDC through June 1999, perinatal transmission accounted for 91% (7,828) of the cases.
- In the 5 years up to and including 1998, 1,880 children under 13 years have died of AIDS.
- In New York City in 1998, AIDS was the leading cause of death in Hispanic children 1 to 4 years of age and was the second leading cause of death for African-American children of the same ages.
- The 8,596 cumulative AIDS cases in children under 13 by race/ethnicity are:
- African-American - 58.4% (5,017)
- Hispanic - 23.2% (1,991)
- White - 17.4% (1,499)
- Asian/Pacific Islander - 0.4% (46)
- American Indian/Alaskan Native - 0.3% (29)(3)
- Perinatally transmitted HIV infection is considered primary infection. Many researchers feel there is an opportunity to prevent HIV infection in young infants with the use of early, aggressive antiretroviral treatment.
- Symptoms and presentation of HIV disease in children can vary. The CDC has developed a classification system for disease based on clinical symptoms and immunologic status.
- Some children with HIV infection will develop serious signs and symptoms within the first year or two of life; these children are considered "rapid progressors". They progress very rapidly to AIDS-defining conditions and have a rapid loss of CD4+ cells within the first two years of life. Symptoms may include failure to thrive, encephalopathy, and/or opportunistic infections.
- A larger group of children presents a more intermediate progression of disease and will tend to develop evidence of severe immunosuppression by seven to eight years of age and have a gradual loss in CD4+ cells. Symptoms may include lymphadenopathy and recurrent childhood illnesses with moderately impaired immune function. This group, the "slower progressors" have a more favorable prognosis.
- A small group of patients remain healthy with minimal to no symptoms of HIV disease and a normal to minimally decreased CD4+ cell count through nine years of age.
- Rapid progressors comprise approximately 20% of patients, intermediate progressors constitute 60% of children and slow progressors (sometimes referred to as long term survivors) were roughly 20% of the patient population prior to the era of highly active antiretroviral therapy (HAART) and early treatment of infants with HIV infection. It is not yet known if early diagnosis and treatment will alter the natural history of pediatric HIV and affect these percentages.
- Studies of large numbers of children with perinatal infection have shown that the median survival time of these children is 8 to 9 years.
- As in adults, viral load (HIV RNA) is the best indicator of disease progression. HIV RNA viral load in young children can be very high (up to 100,000 copies) and persist for prolonged periods.
- Combination antiretroviral therapy is recommended for infants, children, and adolescents with HIV/AIDS.
- Aggressive antiretroviral therapy for primary perinatal infection with three drugs (two NRTI agents and one PI) provides the best opportunity to preserve immune function and delay disease progression.
- Antiretroviral treatment guidelines for infants, children, and youth were published in MMWR in April 1998 (www.hivatis.org).
Pediatrics in October 1998 (www.pediatrics.org) printed a supplemental issue that included medical management of pediatric HIV infection as well as the above antiretroviral therapy recommendations.
- A process is in place to update guidelines as soon as new drugs are approved by the FDA or new information is available. NPHRC is active in guiding the process to assure timely development and dissemination of revisions. The most current recommendations will be maintained by the AIDS Treatment Information Services (ATIS) on their web site (www.hivatis.org).
Guidelines for the Use of Antiretroviral Therapy in Pediatric HIV Infection (April 15, 1999) are available from the menu on the CDC NPIN ftp site: ftp://ftp.cdcnpin.org/Guidelines/ or from the AIDS Treatment Information Service (ATIS) here.
Pediatrics (www.pediatrics.org) printed a supplemental issue that included medical management of pediatric HIV infection. October 1999.
Criteria for the Medical Care of Children and Adolescents with HIV Infection. New York State Department of Health AIDS Institute, September 1999. [Online]. Available at http://www.health.state.ny.us/nysdoh/aids/manuals/children/toc.htm.
- Website regarding information and continuing medical education regarding HIV/AIDS treatment, with emphasis on special populations including infants and children. http://www.hivcme.com.
- "Measles Immunization in HIV-Infected Children." American Academy of Pediatrics Committee on Infectious Diseases and Committee on Pediatric AIDS. Pediatrics. (1999). Vol. 103 No. 5, p. 1057-1060.
- Title IV of the Ryan White CARE Act was authorized in 1990, and reauthorized in 1996, to support the development of infrastructure to provide comprehensive care to children, youth and their families. Title IV projects facilitate linkages between comprehensive care and clinical research and support the participation of HIV infected women, children, adolescents, pregnant women and families in clinical research trials. Services are provided by 270 Title IV sites in 27 states, the District of Columbia and Puerto Rico.
- Medicaid is the largest single payer of direct medical services to people with HIV infection. Medicaid pays for care to 50% of all persons living with AIDS and up to 90% of those persons under 18 years of age living with AIDS.
- Note: The term "children" refers to persons under age 13 at the time of diagnosis. Unless otherwise specified, information is based on Centers for Disease Control HIV/AIDS Surveillance Reports.
- Pediatric HIV/AIDS care ranges throughout the adolescent years; statistics on teens and HIV/AIDS are found in a separate fact sheet.
- A CDC epidemiologist assigned to the Indian Health Service, Dr. Doug Thoroughman, has recently voiced concern that there may be misclassification of HIV/AIDS infections affecting the 500 Indian tribes in the U.S. Under-reporting is also a concern; a recent survey conducted by the Intertribal Council of Arizona found that 58 of the 92 tribal health departments did not report HIV/AIDS statistics to governmental health offices. [Source: Kaiser Daily HIV/AIDS Report, September 7, 1999].
Fact sheet compiled by Catherine Briggs, MD MPH
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