Selected issues in pediatric infection with human immunodeficiency virus

Since the first clinical descriptions of pediatric acquired immunodeficiency syndrome (AIDS) in 1983 and the discovery of human immunodeficiency virus (HIV), AIDS quickly has become a significant threat to the health of children throughout the world. In Central Africa, where the seroprevalence of infection is much higher than in Europe and the United States, HIV infection in children has already become a major medical and public health problem (Lancet 1987, ii:192). In nearly all of these cases, children have acquired the virus from their infected mothers, either in utero or at the time of birth. In North America and Europe, the number of reported cases of AIDS in children has increased steadily. As of June 1989, a total of 1826 cases have been recognized in Europe and the United States (Peckham, presented at 5th International Conference on AIDS, Montreal, 1989). The number of infected but less symptomatic children is estimated to be much larger. The rapid increase in pediatric HIV infections reflects the spread of the virus among women of child-bearing age, due to their infection through sexual contact with an infected individual or from the use of contaminated intravenous needles. Vertical transmission from mother to child now accounts for 78% of cases of AIDS in children reported to the Centers for Disease Control. This percentage is likely to rise because of the rarity of new pediatric infections through other routes (eg, from contaminated blood products). Screening procedures in blood banks have all but eliminated transfusion-associated HIV infection [1]. Nevertheless, for the immediate future, many children have received infected blood or blood products prior to 1985 and will present with symptoms of HIV infection during the next 5 to 10 years.