Impact of
HIV on Infants and Children
- Through December 2006 over 7529
children with AIDS have been reported to CDC
- 91% of cases are the result of vertical transmission
- Childhood AIDS comprises 1.2%
of the cases in the USA opportunistic infections
Impact on Infants
and Children
- Disproportionate impact on
minority children
- •Approximately 85% of
children are Black or Hispanic compared to approximately 53% of infected adults
- •Impact on children who
are already impoverished and who often lack access to health care
Impact of on
Infants and Children
- 30,000 children have lost a
parent
- Prevalence infection among drug
users in some inner city communities is 50%
- Currently the 6th leading cause
of death in children between 1-4 years of age. In cities like Newark and New York, is
already the first or second leading cause of death in Black or Hispanic children between
1-4 years of age.
- is the leading cause of death
among African-American women ages 25-44 in the USA and the 3rd leading cause of death of
American women in this age group
Impact
of on Adolescents and Young Adults
- Adolescents are more similar to adults in
their clinical presentation
- •PCP is the leading diagnosis (33%)
- •Candida esophagitis accounts for 12%
- •Cryptococcosis accounts for 9%
- •Chronic herpes simplex infection accounts for 7.6%
- •Leading non-infectious event is "wasting syndrome"
(18%)
Global I21.8 million people are infected with
- •Women comprise 42%
- •830,000 are infants and children
- Projected to be 60-70 million adults infected by end of year 2000
- Over 9 million children under age 15 have lost their mother
Transmission in Developing Countries
- In adults, both men and women, heterosexual transmission accounts
for 75% of infections
- In infants and children transmission occurs by vertical
transmission and breast feeding
Blood Product Transmission
- 8% of patients with congenital anemia or cancer transfused between
1978-1984 became positive.
- 70-80% of Factor VIII and 40-50% of Factor IX recipients became
positive
- The clinical latency period is approximately 41 months in
children. The clinical latency is longer in children compared to adolescents and adults
Blood Product Transmission
- 3 million people per year receive blood products in the USA,
collected from 18 million donations
- Blood screening went into effect in March, 1985
- In 1995 6% of newly described cases were blood product related,
compared to 19% in 1985
- Overall estimated risk in USA in 1991 is estimated at 1 in 225,000
per unit transfused
- Screening of blood products is still only 55% in developing
countries
Additional Strategies For
Prevention of Blood Product Transmission
- Donor screening, education and exclusion
- Autologous Blood
- Not using directed donations
- Virus inactivation treatment of plasma products
Casual Transmission in Children
- This is exceedingly uncommon and not a source of major concern
- There have been 6 reported cases to date
- •One appears to be due to biting
- •Five were related to exposure to blood or body fluid
exposures
Important Issues in Vertical
Transmission
- Not all infants who are born to infected mothers will be infected
- •Approximately 25% infants will be positive (in the absence
of AZT)
- •Mechanism of transmission of infection to the fetus or
infant
- During pregnancy (approx 30%)
- During labor and delivery (approx 70%)
- By breast feeding (especially in developing
countries)
Factors Associated with Infection in
Infants
- Virus amount - how much is present
- •Varies with the state of the mother's health
- Virus phenotype - how virulent or "infectious"
- Immune protection by mother: antibody or cytotoxic T cells
- Genetics: CD4 and chemokine co-receptors (CCR4
& 5) -- how susceptible are cells to infection
- Other co-infections - disturbance of physical barriers