HIV In Infants and Children

  • The U.S. city with the highest rate of pediatric AIDS through
    2002 was New York City, followed by Miami, FL, and Washington, DC.

  • The disease disproportionately affects children in minority
    groups, especially African Americans. Out of 9,300 cases in children
    under 13 reported to the CDC through December 2002, 59 percent were
    black/non-Hispanic, 23 percent were Hispanic, 17 percent were
    white/non-Hispanic, and less than 1 percent were in other minority
  • New anti-HIV drug therapies and promotion of voluntary testing
    continue to positively effect the death rate. CDC reported a drop of 68
    percent from 1998 to 2002 in the estimated number of children who died
    from AIDS.


    Almost all HIV-infected children acquire the
    virus from their mothers before or during birth or through
    breastfeeding. In the United States, approximately 25 percent of
    pregnant HIV-infected women not receiving AZT therapy have passed on the
    virus to their babies. The rate is significantly higher in developing

    Prior to 1985 when screening of the nation’s blood supply for HIV
    began, some children as well as adults were infected through
    transfusions with blood or blood products contaminated with HIV. A small
    number of children also have been infected through sexual or physical
    abuse by HIV-infected adults.


    Most MTCT, estimated to cause
    more than 90 percent of infections worldwide in infants and children,
    probably occurs late in pregnancy or during birth. Although the precise
    mechanisms are unknown, scientists think HIV may be transmitted when
    maternal blood enters the fetal circulation or by mucosal exposure to
    virus during labor and delivery. The role of the placenta in
    maternal-fetal transmission is unclear and the focus of ongoing

    The risk of MTCT is significantly increased if the mother has
    advanced HIV disease, increased levels of HIV in her bloodstream, or
    fewer numbers of the immune system cells-CD4+ T cells-that are the main
    targets of HIV.

    Other factors that may increase the risk are maternal drug use,
    severe inflammation of fetal membranes, or a prolonged period between
    membrane rupture and delivery. A study sponsored by NIAID and others
    found that HIV-infected women who gave birth more than 4 hours after the
    rupture of the fetal membranes were nearly twice as likely to transmit
    HIV to their infants, as compared to women who delivered within 4 hours
    of membrane rupture.


    HIV also may be transmitted from a
    nursing mother to her infant. Studies have suggested that breastfeeding
    introduces an additional risk of HIV transmission of approximately 10 to
    14 percent among women with chronic HIV infection. In developing
    countries, an estimated one-third to one-half of all HIV infections are
    transmitted through breastfeeding.

    WHO recommends that all HIV-infected women be advised about both the
    risks and benefits of breastfeeding for their infants so they can make
    informed decisions. In countries where safe alternatives to
    breastfeeding are readily available and economically feasible, this
    alternative should be encouraged. In general, in developing countries
    where safe alternatives to breastfeeding are not readily available, the
    benefits of breastfeeding in terms of decreased illness and death due to
    other infectious diseases greatly outweigh the potential risk of HIV


    In 1994, a landmark
    study conducted by the PACTG demonstrated that AZT, given to
    HIV-infected women who had very little or no prior antiretroviral
    therapy and CD4+ T-cell counts above 200/mm3, reduced the
    risk of MTCT by two-thirds, from 25 percent to 8 percent. In the study,
    AZT therapy was initiated in the second or third trimester and continued
    during labor, and infants were treated for 6 weeks following birth. AZT
    produced no serious side effects in mothers or infants. Long-term
    follow up of the infants and mothers is ongoing.

    A few years later, another PACTG study found that the risk of
    transmitting HIV from an HIV-positive mother to her newborn infant could
    be reduced to 1.5 percent in those women who received antiretroviral
    treatment and appropriate medical and obstetrical care during pregnancy.

    Combination therapies have been shown to be beneficial in treating HIV-infected adults, and current guidelines have

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