Pediatric AIDs

Department of Pediatric Dentistry
Lutheran Medical Center

Name: Craig Elice Date: February 26, 2010
Article title: Pediatric Aids
Author(s): Chadwick EG, Yogev R.
Journal: Dental Clinics of North America
Volume (number): 42(4) 969-979
Month, Year: August 1995
Major topic: summary of Pediatric Aids
Type of Article: Review of Literature
Main Purpose: The article provided an overview of the HIV and AIDs.
1 million of 13 million infected persons are children with 80% in sub-saharan populaton. The prenatal transmission rate is 20-30%. Approximately 89% of infected children less than 13 years of age were infected by vertical transmission which is increasing while less than 10% are infected through contaminated blood products. African Americans represent 15% of the childhood population yet represent 50 % pf the pediatric AIDs cases. Adolescents between 13 and 19 represent the fastest growing segment of Aids cases. Risk factors vary by gender in adolescents. 45% of males with AIDs are infected by contaminated blood or blood products while females are infected by heterosexual contact. Transmission: In pediatric populations, vertical transmission is most common with 12-20% transmission rates in US and Europe and igher transmission rates in Africa and Haiti. This vertical transmission can occur intrauterine, during delivery, or less often via breast feeding. Transfusion s of infected blood account for 9% of pediatric AIDs and it appears to be diminishing as a result of HIV antibody screening. HIV is rarely isolated from saliva and does not appear to be a real danger of transmission. Pathogenesis: HIV binds to cells with CD$ molecules (T4 lymphocytes) which migrate to lymph nodes where they become activated and proliferate. Patients develop an immune response which suppresses HIV levels yet causes a deterioration of the immune response. This suppression phase is the clinical “Latency phase”. Eventually the immune system deterioration frees the virus to recirculate through many body tissues Clinical Manifestations: The CDC pediatric guidelines include status of disease: mild to moderate to severe signs and symptoms as well as the immune classification based of absolute T-helper cells count or the Percent of CD4 cells. Recurrent bacterial infections, chonic parotid swelling, LIP, and early onsey of progressive neurological deterioration are characteristic of pediatric AIDs. Infections: The most common serious infections affecting greater than50% of infected children are bacteremia, sepsis, and pneumonia. While adults experience reactivation of latent infections like viruses, most pediatric infections are primary including pneumocystis carinii pneumonia (PCP). Oral candidiasis is the most common fungal disease in HIV infected children. Viral infections like JSV, VZV, and CMV are common. Systemic: CNS involvement in vertically infected children is approximately 20-50% and presents as progressive encephalopathy with loss or stagnation of milestones, cognitive deterioration and stunted brain growth. Recurrent respiratory like otitis and sinusitis are common. LIP affects 1/3 of children presenting as lymphoid hyperplasia of the bronchia tubules causing blockage of the alveolar/ capillary interface. PCP is the most common opportunistic infection in pediatric AIDs Cardiac involvement in patients with HIV infection has been thoroughly studied. GI involvement is common with symptoms of chronic and recurrent diarrhea with malabsorption abdominal pain, dysphagia, and failure to thrive (FTT). Chronic liver inflammation is common. Renal disease is an uncommon finding. Skin diseases although present in healthy children, are common in HIV infected children. Recurrent and chronic primary infections with HSV, Zoster, and other viruses are common as well as fungal diseases as well as hyperkeratosis. Malignant diseases are rare in pediatric AIDs. Diagnosis is confirmed using immunoassay for IgG antibody to HIV after 18 months of age, while diagnosis is made by virus culture in infants. Management: Focus is placed on nutritional status of patients and prevention of PCP which is difficult as PCP sometimes precedes the diagnosis of AIDs. Guidelines from the CDC for prophylaxis target infants born to infected mothers or shown to be infected by HIV. Therapy includes use of Zidouridine as the first drug of choice in children who have a reduced CD4 count and symptoms of AIDs. Combinations of other meds like Didanosine and others are being investigated. Prognosis is poor when the patient is symptomatic during the first year of life. Opportunistic infections, encephalopathy also carry a poor prognosis.
Key points/Summary: Describes the pathophysiology of pediatric AIDs.
Assessment of article: Good article but may need an update.