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  • Title: Paediatric HIV infection.
    Author: Friesen H.
    Journal: P N G Med J; 1996 Sep; 39(3):183-9. PubMed ID: 9795560.
    Abstract:
    HIV infection in children is a family disease, with social, economic and medical aspects that make it one of the most challenging diseases of our time. Knowledge about the factors involved in mother-to-child transmission and the natural history of the disease is gradually increasing although there is still much to understand. As the majority of children become infected through mother-to-child transmission, perinatally acquired infection will parallel increases in heterosexual transmission and the numbers of infected women of childbearing age. Current estimates of the rate of vertical transmission range from 14% to 39% in different studies. The relative proportion of transmission occurring in utero, peripartum or postpartum may vary in different localities and remains unclear. A study recently carried out in the USA showed that zidovudine given late in pregnancy, peripartum and in the neonatal period decreases HIV transmission from 25% to 8%. The clinical presentation of HIV infection in children depends in part on exposure to different infections. In developing countries the children usually present with nonspecific signs and symptoms, such as failure to thrive, chronic diarrhoea, cough and recurrent bacterial infections. Other common presentations include generalized lymphadenopathy, oropharyngeal candidiasis, dermatitis, enlargement of parotid glands and neurological problems, including delayed development. Since the majority of children with HIV are infected through vertical transmission, perinatally acquired infection parallels increases in heterosexual HIV transmission and the numbers of seropositive women of childbearing age. Various studies have estimated the rate of vertical transmission at 14-39%, but the relative proportion of transmission occurring in utero, peripartum, and postpartum remains unclear. Zidovudine administration in late pregnancy, peripartum, and the neonatal period has been shown, in the US, to reduce HIV transmission from 25% to 8%. In developing countries, HIV-infected children generally present with nonspecific signs and symptoms such as failure to thrive, chronic diarrhea, cough, and recurrent bacterial infections. Other common presentations include generalized lymphadenopathy, oropharyngeal candidiasis, dermatitis, enlargement of parotid glands, and neurological problems such as delayed development. The World Health Organization has delineated guidelines for recognizing pediatric HIV infection in developing countries where HIV testing is unavailable or unaffordable. These guidelines encompass cardinal, characteristic, and associated findings in combination with epidemiologic risk factors. The prognosis of pediatric AIDS depends on factors such as age of presentation, severity of AIDS diagnosis, and the availability of health care and drugs to treat opportunistic infections.
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