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HIV Treatment in Children

Topic Overview

What is HIV?

HIV (human immunodeficiency virus) is a virus that attacks the immune system, the body's natural defense system. Without a strong immune system, the body has trouble fighting off disease. Both the virus and the infection it causes are called HIV.

White blood cells are an important part of the immune system. HIV invades and destroys certain white blood cells called CD4+ cells. If too many CD4 cells are destroyed, the body can no longer defend itself against infection.

The last stage of HIV infection is AIDS (acquired immunodeficiency syndrome). People with AIDS have a low number of CD4+ cells and get infections or cancers that rarely occur in healthy people. These can be deadly.

If your child has HIV, it doesn't mean that he or she has AIDS. It takes a long time for HIV to progress to AIDS. If HIV is diagnosed before it becomes AIDS, medicines can slow or stop the damage to the immune system. Early treatment can help your child live a long and active life.

How do children get HIV?

Women who have HIV while they are pregnant can give it to their babies during their pregnancy or during delivery. They can also pass it on through breast milk. Older children and teens may be infected if they have unprotected sex or share infected needles.

When are children tested for HIV?

HIV infections get worse quickly in the very young. The sooner the doctor can diagnose HIV, the more quickly and aggressively he or she can treat the infection. Children who are at high risk of being infected with HIV are tested as early as possible. If the mother had HIV during her pregnancy and wasn't treated for it, her newborn may be given a blood test at birth. The doctor won't wait for symptoms to appear.

More tests will be given as the baby grows. The baby will be tested for HIV within 2 to 3 weeks of birth and again in the months to come. The baby will be considered free of HIV infection if there are no symptoms and he or she is tested for the presence of the HIV virus at about 1 month, 4 months, and 6 months and all test results are negative.

All children, regardless of age, who have an HIV-positive mother are tested for HIV whether they show symptoms or not. Children who go to the doctor with HIV-like symptoms are tested as part of their exam.

How is HIV treated in children?

The standard treatment for HIV is a combination of medicines called antiretroviral therapy (ART). ART medicines slow the rate at which the virus multiplies. Taking these medicines can reduce the amount of virus in your child's body and help your child stay healthy. The ART medicines are available as powders and flavored syrups that you can mix with your child's food. When your child is old enough to take pills, he or she may take them 1 or 2 times a day, as directed by the doctor.

Doctors follow certain guidelines in deciding when to start giving ART medicines to children with HIV:1

  • Infants younger than 12 months old should start treatment as soon as they are diagnosed.
  • Children between 1 and 3 years old should start ART if they have CD4+ counts less than 1000 or CD4+ levels less than 25%.
  • Children from 3 years up to 5 years old should start ART if they have CD4+ counts less than 750 or CD4+ levels less than 25%.
  • Children 5 years old and older should start ART if they have CD4+ counts of 500 or less.
  • Pregnant teenagers should begin ART whether they have symptoms or not.

Your child will need to take ART medicines for the rest of his or her life. It's important for your child to take the medicines exactly as the doctor prescribes them, with no skipped doses. If the medicines aren't taken as prescribed, the HIV virus can become drug-resistant and make the infection harder to treat.

Staying with a strict treatment program can be difficult. It helps to associate taking the medicine with your child's daily routine. For example, have your child take the medicine with breakfast or before brushing his or her teeth. You can also put the week's pills in a pillbox and post reminders on calendars, use sticky notes, and set cell phone alarms.

What's ahead for a child with HIV?

Children who take their ART medicines as directed have a good chance of living a long, healthy life. Your child can go to school and take part in sports and other activities. You can help by making sure that your child takes his or her medicine, eats nutritious food, gets plenty of exercise, and has all immunizations on schedule.

References

Citations

  1. Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children (2011). Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. Available online: http://aidsinfo.nih.gov/ContentFiles/PediatricGuidelines.pdf.

Other Works Consulted

  • Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children (2011). Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. Available online: http://aidsinfo.nih.gov/ContentFiles/PediatricGuidelines.pdf.
  • Simpkins EP, et al. (2009). Thinking about HIV infection. Pediatrics in Review, 30(9): 337–349.

Credits

By Healthwise Staff
E. Gregory Thompson, MD - Internal Medicine
Peter Shalit, MD, PhD - Internal Medicine
Last Revised April 12, 2013

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