Acquired immunodeficiency syndrome has become one of the main medical problems of the 20th century. This disease provokes a virus that leads to inhibition of the human immune system. The infection does not pass by and children. HIV in a child has its own characteristics of the course and therapy, which we will consider further.
Why does the development of the disease begin?
The source of infection is an AIDS patient or a carrier of the virus. The peculiarity of the microorganism is such that for several years it can be in the body and not provoke the appearance of negative symptoms.
AIDS is the final stage of the disease, which leads to serious complications and death. The virus can be detected in any biological fluid, penetrating into a healthy body of a child, it causes the death of cells responsible for immunity.
At the first stages, the body copes, compensating for the loss of the production of new cells. But this does not always continue, the immune system of HIV-infected children is greatly depleted and the body becomes susceptible to any infections that lead to death.
How do children get infected?
It is not the virus itself that is dangerous for the body of a child or adult, but the consequences to which it leads. HIV transmission to a child can occur in the following ways:
- During intrauterine development through the fetal membrane, the placenta.
- While breastfeeding with infected colostrum.
- Mother-to-child HIV can be transmitted through labor during passage through the birth canal.
- Through damaged skin with a tool that was poorly processed.
- In the process of blood transfusion or transplantation of internal organs.
The sooner the infection occurs, the harder the HIV infection in children.
Virus detection in children
An accurate diagnosis is made only after a full examination, which includes the following tests:
- Polymerase chain reaction. The study allows you to detect HIV RNA in the body.
- Determination of immune status. It must be borne in mind that the immunity in children is still not fully formed, so the result of the analysis differs from that in adults. This HIV analysis of the child will be lower in terms of indicators.
- Determination of viral load. And this indicator will be higher for HIV than for adults.
- IFA. The analysis allows you to detect antibodies to the immunodeficiency virus in the blood . If the result is positive, then do the analysis again, using the method of immune blotting.
Doctors should take into account the fact that the ELISA method does not detect an infection in the first six months after it enters the body. During this period, the immune system is still trying to fight, so repeated studies are needed after 3 and 6 months, if there is a suspicion of infection.
First symptoms of infection
After the introduction of the virus into the body, the incubation period begins. It can take from several months to 10 years until the first symptoms of HIV in a child appear. It all depends on the age of infection.
After the incubation phase, the disease develops rapidly. If the children are HIV-positive, then the following symptoms can be observed:
- Body temperature over 38 degrees. Such indicators can last up to several weeks. So the body reacts to viruses.
- Lymph nodes increase.
- Intensive perspiration begins.
- On ultrasound, the liver and spleen are enlarged.
- A rash may appear on the body.
- There are changes in the analyzes.
If children have HIV infection, then disorders of the nervous system are often observed. Depending on the involvement of different departments, the following are noted:
- Encephalitis. The disease manifests itself as forgetfulness, muscle weakness in the first stages, and then the temperature rises, convulsions appear.
- Meningitis. It begins with headaches, nausea and vomiting, and then the temperature rises, the child loses weight, quickly gets tired.
- Myelopathy develops with damage to the spinal cord. There is weakness in the legs, which gradually turns into a complete immobility. The functioning of the pelvic organs is impaired, sensitivity decreases. With damage to the peripheral nerve endings, polyneuropathy develops. The volume of muscle tissue, immobility is reduced.
- Encephalopathy With this pathology, memory suffers, motility is impaired, fatigue and lethargy appear.
In infants, signs of damage to the nervous system most clearly become visible by 2 months:
- Convulsions appear.
- Muscles are in an increased tone, not only during movements, but also at rest.
- There is an inconsistent work of the movements of the arms and legs.
- Impaired mental function.
Symptoms of HIV in a child at any age are almost the same, but some features can be highlighted.
If a newborn was born with this infection, then, as a rule, this happens prematurely or the infant is behind in weight from its peers. Also, infected children with HIV in utero are characterized by herpes or cytomegalovirus infection. It is possible to note characteristic external signs: a shortened nose, a large forehead, strabismus, plump lips, developmental defects.
In children infected during passage through the birth canal, symptoms often appear closer to six months:
- Poorly gaining weight.
- Lymph nodes are enlarged.
- Mental and physical development is disrupted: they start to sit and walk late.
- Elevated body temperature.
- Skin rashes and fungal infections.
- Stomatitis.
- The work of the heart, respiratory organs, and kidneys is disrupted.
- The child does not eat well, nausea and vomiting appear.
- Infectious diseases are often observed.
- A blood test shows a low level of white blood cells and platelets.
If the baby was born healthy, HIV entered the body later, then among the symptoms, in addition to the enlarged lymph nodes and fever, the following diseases are often observed:
- Pneumocystis pneumonia with an obsessive cough, increased sweating, high fever.
- Interstitial pneumonia
- The course is sluggish with a cough without sputum separation, shortness of breath with increasing respiratory failure.
- Brain tumors and Kaposi's sarcoma. These pathologies develop much less frequently.
Symptoms of HIV in children at any age manifest in behavior. The child does not sleep well, loses his appetite, there is apathy, a bad mood.
Child from HIV parents
If the immunodeficiency virus is present in the body of the parents, this does not mean at all that the baby will also be born sick. In 98% of cases, healthy children are born from HIV patients, thanks to modern treatment methods. If a woman is a carrier of the virus or sick with AIDS, then pregnancy must be planned.
The risk of having a sick baby is increased if:
- In the mother's blood, a high concentration of the virus.
- Treatment is not carried out or selected is not effective.
- A premature discharge of amniotic fluid occurred.
- The baby is premature.
- There was a baby injury during childbirth.
To reduce the likelihood of infection, future mothers with HIV infection are most often given a cesarean section.
Treatment principles
Unfortunately, the modern possibilities of medicine do not completely relieve the patient of a terrible disease. It is only possible for a while to normalize the condition and restrain the reproduction of the virus.
If the child was born HIV-infected or acquired the disease after birth, then they are guided by the following principles of treatment:
- Conducting antiretroviral therapy. If there are concomitant secondary diseases provoked by suppressed immunity, symptomatic treatment is required.
- Therapy is prescribed only after receiving an AIDS treatment specialist and with the consent of the parents or legal representatives.
For successful therapy, it is important to follow the following rules:
- All medicines for the treatment of HIV infection are issued only in a specialized medical institution.
- The doctor gives recommendations on the frequency of administration, dosage and parents must strictly observe them, otherwise all treatment will be in vain.
- For more successful treatment, several medications are always prescribed so that the viral particles have no chance to adapt to them.
- Therapy most often in the presence of HIV in a child is carried out on an outpatient basis, only in urgent cases, if indicated, hospitalization is necessary.
Antiretroviral therapy for children is prescribed if there are certain indications, but for babies in their first year of life, this is mandatory. At an older age, indications for such treatment are:
- The immune status of the child is less than 15%.
- The number of immune cells is in the range of 15-20%, but there are complications in the form of bacterial diseases.
Antiretroviral Therapy
The main treatment for confirming HIV infection is HAART. To increase the effectiveness, a combination of several drugs is used. One medicine is most often used for preventive purposes or for those children whose HIV status is uncertain.
Medicine has a large number of effective drugs in its arsenal, most often the following are combined with each other:
- "Videx".
- "Lamivudine."
- "Zidovudine."
- "Abacavir."
- "Olithid."
- "Retrovir."
If the baby is born infected, then from 1-1.5 months begins the prevention of pneumonia. Assign to the baby:
- Septrin or Bactrim.
- "Trimethoprim" in an amount of 5 mg per kilogram of weight.
- 75 mg Sulfamethoxazole three times a week.
Together with the listed medicines, others are also prescribed:
- Non-nucleoside reverse transcriptase inhibitors: Nevirapine, Atevirdine.
- Protease inhibitors: Saquinavir, Crixivan.
But the appointment of these drugs requires caution and constant monitoring of the condition of the child, since therapy is fraught with the development of many adverse reactions: neuropathy, pathology of the gastrointestinal tract.
Treatment of HIV infection is carried out under constant monitoring of the state of the child’s immune system. It is important to simultaneously prevent the attachment of secondary infections and the development of neoplasms.
If a healthy child has conditionally pathogenic microorganisms practically do not cause the development of diseases, then HIV-infected or AIDS patients have a weakened immune system that is not able to withstand them. When they appear, therapy is accompanied by the selection of the drug, taking into account the nature of the pathogen.
Therapy is also always carried out using not only specialized antiviral drugs, but also are prescribed:
- Vitamin preparations.
- Medicines that have a general strengthening effect.
- Biologically active additives.
Doctors note that treatment in childhood will be more successful the sooner it is started. But parents should understand that their child’s health and life expectancy is completely dependent on compliance with all medical recommendations. You have to be prepared for the fact that you have to take medications for a long time, and maybe all your life. In addition, observe the daily regimen, adhere to a certain diet.
How to prevent the birth of a sick child from an infected woman?
HIV prevention for children should begin long before the baby is born if the expectant mother has a disease or she is a carrier of the virus. The risk of transmission to a developing baby is about 15% and during the first trimester it is much higher due to an unstable placenta.
A sick woman can give birth to a healthy baby if she follows a number of recommendations:
- Before 2-2.5 months of pregnancy, undergo chemotherapy.
- Take antiretroviral drugs prescribed by your doctor. Usually, from 14 to 34 weeks, “Retrovir” is prescribed in an amount of 100 mg 5 times a day.
- Regularly attend a consultation and take tests to track the dynamics of an infant's development and prevent anemia.
Medical measures during childbirth
Women who are carriers of HIV infection are not forbidden to give birth naturally, but it is not recommended to use various methods of obstetric care: obstetric forceps or vacuum aspiration. In practice, doctors do not want to take risks, given that HIV is transmitted to children at the time of passage through the birth canal, they do a cesarean section.
An hour before the expected time of birth, the baby, the future mother is given the drug "Zidovudine." During labor, “Retrovir” is administered intravenously by drip at the rate of 2 mg per kilogram of woman's weight.
All doctors and nurses taking care of the baby and subsequently looking after the baby must have a bathrobe, mask and gloves.
What is being done right after birth
A newborn baby is not isolated from mom, but breastfeeding is strictly prohibited. Colostrum can contain viral particles and cause infection. Following childbirth, the following is recommended:
- Retrovir syrup is given to a newborn infant at 2 mg per kilogram of the baby’s mass every 6 hours. Such therapy lasts 1.5 months of a child’s life.
- Get vaccinated against hepatitis B.
- Make a blood test.
- Conduct an outpatient examination of the baby.
Vaccination of children from infected mothers
Immunization of infants from sick mothers is even more necessary than for healthy children. It will strengthen the immune system and increase its resistance to dangerous infections. The following drugs are used for vaccination:
- DTP.
- Polio vaccine.
- Against hepatitis B.
- Vaccination against measles and mumps.
Doctors should carefully monitor the reactions of the child's body after vaccination.
Recommendations for parents of children with HIV positive status
When a sick child is born or after infection after birth, a great responsibility rests with the parents. A lot in the state of the baby will depend on their behavior. Compliance with some principles will help prolong a child’s life:
- Mandatory registration at the AIDS treatment center and local clinic.
- A doctor visit is necessary for an examination every three months.
- HIV-infected children are seen by a TB doctor and neurologist.
- Regularly tested for immune status and viral load.
- Every 6 months, a Mantoux reaction is done.
- Once every six months, a biochemical analysis of blood and urine is taken, and the sugar level is measured.
- Parents should consider that the caloric intake of HIV-infected children should be increased by 30%. Nutrition should be rational and balanced with the content of all the necessary vitamins and minerals.
- All vaccinations should be given on schedule. It can only be changed by the attending physician if there is evidence for this.
Parents should tell their child in an accessible way that HIV has now become an integral part of their lives. He must know this in order to properly fight the infection and comply with all the recommendations of doctors.
Do not focus on the negative, you need to make it clear to the baby that you will always be with him and support him in any situation. HIV is not transmitted through household contacts, so these children can attend regular kindergartens and schools. But this is not all simple, unfortunately, in our society, people with AIDS are neglected.
Despite the fact that AIDS and HIV infection cannot be completely cured, timely access to specialists and effective therapy will improve the condition of a small patient.