What you have to know about HIV and AIDS.
HIV and AIDSAIDS stands for acquired immunodeficiency syndrome, a
disease that makes it difficult for the body to fight off infectious
diseases. The human immunodeficiency virus known as HIV causes AIDS by
infecting and damaging part of the body's defenses against infection, namely
the white blood cells known as lymphocytes, a type of white blood cell
in the body's immune (infection-fighting) system that is supposed to
fight off invading germs.
HIV can be transmitted through direct contact with the blood or body
fluid of someone who is infected with the virus. That contact usually
comes from sharing needles or by having unprotected sex with an infected
person. An infant could get HIV from a mother who is infected.
Though there are treatments for HIV and AIDS, there are no vaccines or
cures for them. But there are things you can do to prevent you and your
child from getting the disease.
What Does HIV Do to the Body?
The virus attacks specific lymphocytes called T helper cells (also
known as T-cells), takes them over, and multiplies. This destroys more
T-cells, which damages the body's ability to fight off invading germs and
disease.
When the number of T-cells falls to a very low level, people with HIV
become more susceptible to other infections and they may get certain
types of cancer that a healthy body would normally be able to fight off.
This weakened immunity (or immune deficiency) is known as AIDS and can
result in severe life-threatening infections, some forms of cancer, and
the deterioration of the nervous system. Although AIDS is always the
result of an HIV infection, not everyone with HIV has AIDS. In fact,
adults who become infected with HIV may appear healthy for years before
they get sick with AIDS.
How Common Are HIV and AIDS?
The first case of AIDS was reported in 1981, but the disease may have
existed unrecognized for many years before that. HIV infection leading
to AIDS has been a major cause of illness and death among children,
teens, and young adults worldwide. AIDS has been the sixth leading cause of
death in the United States among 15- to 24-year-olds since 1991.
In recent years, AIDS infection rates have been increasing rapidly
among teens and young adults. Half of all new HIV infections in the United
States occur in people who are under 25 years old; thousands of teens
acquire new HIV infections each year. Most new HIV cases in younger
people are transmitted through unprotected sex; one third of these cases
are from injection drug usage - the sharing of dirty, blood-contaminated
needles.
Among children, most cases of AIDS - and almost all new HIV infections
- resulted from transmission of the HIV virus from the mother to her
child during pregnancy, birth, or through breastfeeding.
Fortunately, medicines currently given to HIV-positive pregnant women
have reduced mother-to-child HIV transmission tremendously in the United
States. These drugs (discussed in detail in the Treatment section of
this article) are also used to slow or reduce some of the effects of the
disease in people who are already infected. Unfortunately, these
medicines have not been readily available worldwide, particularly in the
poorer nations hardest hit by the epidemic. Providing access to these
life-saving treatments has become an issue of global importance.
How Is HIV Transmitted?
HIV is transmitted through direct contact with the blood or body fluid
of someone who is infected with the virus.
The three main ways the HIV virus is passed to a very young child are:
while the baby develops in the mother's uterus (intrauterine)
at the time of birth
during breastfeeding
Among teens, the virus is most commonly spread through high-risk
behaviors including:
unprotected sexual intercourse (oral, vaginal, or anal sex)
sharing needles used to inject drugs or other substances (including
contaminated needles used for injecting steroids and tattooing and body
art)
In very rare cases, HIV has also been transmitted by direct contact
with an open wound of an infected person (the virus may be introduced
through a small cut or tear on the body of the healthy person) and through
blood transfusions. Since 1985, the U.S. blood supply has been
carefully screened for HIV.
Signs and Symptoms of HIV
Although there may be no immediate physical signs of HIV infection at
birth, signs of the infection might appear within 2 to 3 months after a
child is born. Kids who are born with HIV can develop opportunistic
infections, which are illnesses that can develop in weakened immune
systems, such as Pneumocystis carinii pneumonia (PCP). A child with HIV may
also get more severe bouts of other common childhood infections, such as
Epstein-Barr virus (EBV) infection, which generally causes mild illness
in most kids. In developing countries, tuberculosis has been a
particularly common problem and often the cause of death of children and
adults.
A baby born with HIV infection most likely will appear healthy. But
sometimes, within 2 to 3 months after birth, an infected baby may begin to
appear sick, with poor weight gain, repeated fungal mouth infections
(thrush), enlarged lymph nodes, enlarged liver or spleen, neurological
problems, and multiple bacterial infections, including pneumonia.
Teens and young adults who contract HIV usually show no symptoms at the
time of infection. In fact, it may take up to 10 years or more for
symptoms to show. During this time, they can pass on the virus without even
knowing they have it themselves. Once the symptoms of AIDS appear, they
can include rapid weight loss, intense fatigue, swollen lymph nodes,
persistent diarrhea, night sweats, or pneumonia. They, too, will be
susceptible to life-threatening opportunistic infections.
Diagnosing HIV Infections and AIDS
Every pregnant woman should be tested for HIV to have a better chance
of preventing transmission to her unborn child.
If a woman knows she is HIV-infected and already has children, then it
is recommended that all of her children be tested for HIV. Even if she
has older children and they seem healthy, they could still have an HIV
infection if she was already HIV-positive at the time they were born. A
blood test is needed to know for sure.
However, when a new baby is born to an HIV-infected mother, there is no
immediate way to know whether the baby is infected with the virus. This
is because if the mother is infected, an ELISA test to check for HIV
antibodies in a newborn's blood will almost always be positive, too.
Babies will have their HIV-infected mother's antibodies (which are passed
to the baby through the placenta) even if they are not truly infected
with HIV. These babies may remain HIV-antibody positive for up to 18
months after birth, even if they are not actually infected.
Infants who are not actually infected with the virus (but are born to
HIV-positive mothers) will not make their own antibodies; the HIV
antibodies that came from their mothers will gradually disappear from their
blood before they reach 2 years of age. Any blood tests performed after
this point will likely be HIV-negative. Infants who are infected with
HIV from their mothers will begin to make their own HIV antibodies and
will generally remain HIV-positive after 18 months of age.
The most accurate diagnosis of HIV infection in early infancy comes
from tests that show the presence of the virus itself (not HIV antibodies)
in the body. These tests include an HIV viral culture and PCR
(polymerase chain reaction), a blood test that looks for the DNA of the virus.
Older children, teens, and adults are tested for HIV infection by a
blood test known as an ELISA test, which detects the presence of HIV
antibodies in the blood. Antibodies are specific proteins that the body
produces to fight infections; HIV-specific antibodies are produced in
response to infection with HIV. Someone with antibodies against HIV is said
to be HIV-positive. If the ELISA test is positive it is always
confirmed by another test called a Western blot. If both of these tests are
positive, the patient is almost certainly infected with the HIV virus.
Can Young Children Spread HIV?
Across the United States, there have been only a handful of reported
cases where HIV infection was contagious from a child to another person.
All of those cases involved direct blood contact within a household.
The typical baby secretions (urine, drool, spit up, vomit, feces, etc.)
do not seem to transmit the virus, so routine care of babies with HIV is
considered safe.
Despite widespread concerns, there are no reported transmissions of the
HIV virus within a school or child-care setting. Because the danger in
transmitting HIV involves direct contact with blood, personnel at
schools and child-care programs should routinely use gloves when any child
has a cut, scrape, or is bleeding.
Transmission of HIV Among Teens
Among teens, HIV is spread mostly through unprotected sex with an
infected person or sharing intravenous drug needles. Education of children
and teens is vitally important to help prevent sexual transmission of
HIV, as well as other sexually transmitted diseases (STDs), including
chlamydia, genital herpes, gonorrhea, hepatitis B, syphilis, and genital
warts. Many STDs cause irritation, sores, or ulcers of the skin and
mucous membranes through which the virus can pass. Having an STD, such as
genital herpes, for example, has been proven to increase a person's risk
of getting HIV if he or she has unprotected sex with someone who is
HIV-positive.
HIV is not spread through:
casual contact, such as hugs or handshakes
drinking glasses
sneezes
coughs
mosquitoes or other insects
towels
toilet seats
doorknobs
Opportunistic Infections
Opportunistic infections (infections that take advantage of a person's
weakened immune system) are the most common complication of HIV/AIDS.
Sometimes adults with HIV/AIDS can get an infection from germs that do
not normally cause illness in a healthy person (like cryptococcus).
People with AIDS (especially children) can get a severe version of a more
common infection, such as salmonella (a type of diarrhea-causing
bacteria) and chickenpox. In children with HIV, the following opportunistic
infections and conditions can frequently occur:
viral infections, such as lymphoid interstitial pneumonia (LIP), a form
of chronic walking pneumonia, herpes simplex virus, shingles, and the
cytomegalovirus infection
parasitic infections, such as PCP, a pneumonia caused by Pneumocystis
carinii, a microscopic parasite that can't be fought off due to a
weakened immune system, and toxoplasmosis
serious bacterial infections, such as bacterial meningitis,
tuberculosis, and salmonellosis
fungal infections such as esophagitis (inflammation of the esophagus),
and candidiasis or thrush (yeast infection)
Other Complications
Children with HIV are also at higher risk for some forms of cancer
because of their weakened immune systems. Lymphomas associated with EBV
infection are more common in older children with HIV.
The most difficult conditions to treat in children who have HIV or AIDS
are the wasting syndrome (the inability to maintain body weight due to
long-term poor appetite and other infections related to HIV disease)
and HIV encephalopathy (due to HIV infection of the brain that causes
swelling and then damage to the brain's tissues over time). HIV
encephalopathy results in AIDS dementia, especially in adults. Wasting syndrome
can sometimes be helped with nutritional counseling and daily
high-calorie supplements, but preventing HIV encephalopathy remains extremely
difficult.
Treating AIDS and HIV
There have been two major advances in the treatment of HIV/AIDS over
the last 20 years. One is the development of drugs that inhibit the
virus's growth, preventing or delaying the onset of AIDS and allowing people
living with HIV to remain free of symptoms longer. The other is the
development of medications that have proven very important in reducing the
transmission of the virus from an HIV-infected mother to her child.
Drug Treatments
As medical understanding about how the virus invades the body and
multiplies within cells has increased, drugs to inhibit its growth and slow
its spread have been developed. Drug treatment for HIV/AIDS is
complicated and expensive, but highly effective in slowing the replication
(reproduction) of the virus and preventing or reducing some effects of the
disease.
Drugs to treat HIV/AIDS use at least three strategies, including:
interfering with HIV's reproduction of its genetic material (these
drugs are classified as nucleoside or nucleotide anti-retrovirals)
interfering with the enzymes HIV needs to take over certain body cells
(these are called protease inhibitors)
interfering with HIV's ability to pack its genetic material into viral
code - that is, the genetic "script" HIV needs to be able to reproduce
itself (these are called non-nucleoside reverse transcriptase
inhibitors [NNRTIs])
Because these drugs work in different ways, doctors generally prescribe
a "combination cocktail" of these drugs that are taken every day. This
regimen is known as HAART treatment (HAART stands for highly active
antiretroviral therapy). Doctors may also prescribe drugs to prevent
certain opportunistic infections - for example, some antibiotics can help
prevent PCP, especially in kids.
Although a number of medicines are available to treat HIV infection and
slow the onset of AIDS, unless they are taken and administered properly
on a round-the-clock schedule, the virus can quickly become resistant
to that particular mix of medications. The HIV virus is very adaptable
and finds ways to outsmart medical treatments that are not followed
properly. This means that if prescribed medicines are not taken at the
correct times every day, they will soon fail to keep HIV from reproducing
and taking over the body. When that happens, a new regimen will need to
be established with different drugs. And if this new mix of medicines
is not taken correctly, the virus will likely become resistant to it as
well and eventually the person will run out of treatment options.
Aside from the difficulty of getting young children to take their
medication on a timed schedule, the medications present other problems. Some
have unpleasant side effects, such as a bad flavor, whereas others are
only available in pill form, which may be difficult for children to
swallow. Parents who need to give their child these medications should ask
the doctor or pharmacist for suggestions on making them easier to take.
Many pharmacies now offer flavoring that can be added to bad-tasting
medicines, or your child's doctor may recommend mixing pills with
applesauce or pudding.
Because the number of drugs described above is still limited, doctors
are concerned that, if children fail to take their medicines as
prescribed (even missing just a few doses), the virus could eventually develop
resistance to existing HIV drugs - making treatment difficult or
impossible. It is then doubly important that children take their medications
as directed. One of the most important home treatment messages for any
parent or caregiver of a child with HIV is that the child should take
all of his or her medications consistently, at the time the prescription
indicates. This can be difficult - but many HIV/AIDS family support
groups and experienced medical providers can help families with practical
suggestions to help them be successful with the many day-to-day
challenges they face.
Many of the new medications that fight HIV infection are expensive. One
of the major challenges facing individuals, families, communities, and
nations is how to make these medications easily available to all that
need them.
Preventing Mother-to-Child Transmission of HIV
When a pregnant HIV-infected woman receives good medical care early and
takes antiviral medications regularly during her pregnancy, the chance
that she will pass HIV to her unborn baby is dramatically reduced.
It is important that any woman who is pregnant and knows she is
HIV-positive start prenatal care as soon as possible to take full advantage of
such treatments. The sooner a mother receives treatment, the greater
the likelihood that her baby will not get HIV.
An HIV-infected mother can receive medical treatment:
before the birth of her baby - antiviral treatments given to the mother
in the third trimester can help prevent HIV transmission to the baby
at the time of birth - antiviral medications can be given to both the
mother and the newborn child to lower the risk of HIV transmission that
can occur during the birth process (which exposes the newborn to the
mother's blood and fluids); in addition, the mother will be encouraged to
formula-feed rather than breastfeed her infant because HIV can be
transmitted to her baby through breast milk
during breastfeeding - because breastfeeding is discouraged among
HIV-infected mothers, this type of transmission is rare in the United
States. However, in places in the world where formula is not readily
available, both the mother and child can be treated with medication to lower
the risk of the HIV infection to the breastfeeding child
In the past, before antiviral medicines were routinely given, almost
25% of children born to HIV-infected mothers developed the disease and
died by 24 months of age. Recent studies have shown that mothers with HIV
or AIDS who get good prenatal care and regularly take antiviral drugs
during their pregnancy now have less than a 5% chance of passing HIV to
their babies. If these babies do get the HIV virus, they tend to be
born with a lower viral load (less HIV virus is present in their bodies)
and have a better chance of long-term, disease-free survival.
Long-Term Care of Children With HIV/AIDS
Cases of HIV infection and AIDS in children are complicated and should
be managed by experienced health care professionals. Children will need
to have their treatment schedules closely monitored and adjusted
regularly. Any infections that could become life threatening must be quickly
recognized and treated.
Medicines are adjusted in relation to the child's viral load. The
child's health is also monitored by frequent measurement of T-cell levels
because these are the cells that the HIV virus destroys. A good T-cell
count is a positive sign that medical treatments are working to keep the
disease under control.
Children will need to visit their health care providers often for blood
work, physical examinations, and discussions about how they and their
families are coping socially with any stress from their disease. Some
immunizations during routine visits may be slightly different for infants
or children with HIV/AIDS. If the child's immune system is severely
compromised, he or she will not receive live virus vaccines including
measles-mumps-rubella and varicella [chickenpox]. All other routine
immunizations are given as usual, and a yearly influenza vaccine (flu shot) is
recommended as well.
If a family seeks health care in a hospital emergency department,
parents should be sure to tell the nurse who registers the child that the
child has HIV; this will alert medical caregivers to look closely for any
signs of diseases from opportunistic infections and provide the best
possible treatment.
Outlook for HIV and AIDS
There is no known cure for HIV or AIDS. Although current treatments can
slow the progression of HIV disease, life expectancy is still reduced
significantly. Children who acquire HIV at birth develop AIDS sooner and
tend to have more serious complications than adults with the virus. At
this time, few children who were infected with HIV at birth have
survived into adulthood, though much progress is being made in AIDS research
and treatment.
Although all children, teens, and adults with HIV will eventually
become sick, recent medical advances have prolonged their survival. Drug
treatments can allow people living with HIV to remain free of symptoms for
longer and can improve quality of life for people living with AIDS. The
search goes on for a vaccine that might prevent HIV infection. But even
if such a vaccine is developed, it is likely years away. That's why
prevention of HIV remains of worldwide importance today.
Preventing HIV and AIDS
Despite much research, there is no vaccine that will prevent HIV
infection. Only the avoidance of risky behaviors can do this. Among U.S.
teens and adults, HIV transmission is almost always the result of sexual
contact with an infected person or sharing contaminated needles.
Infection can be prevented by never sharing needles, and abstaining, or not
having oral, vaginal, or anal sex.
Risk can be substantially reduced by always using latex condoms for all
types of sexual intercourse, and avoiding contact with the blood,
semen, vaginal fluids, and breast milk of an infected person.
Avoidance of alcohol and drugs is also key in preventing the spread of
HIV - not because a person can get HIV directly from drinking and doing
drugs, but because drinking and drug use often leads to risky behaviors
that are associated with an increased risk of infection (such as having
unprotected sex and sharing needles).
The most important means of preventing HIV/AIDS in infancy is to test
all pregnant women for the virus. If the result is positive, treatment
can immediately begin before the baby is born to prevent HIV
transmission.
Talking With Your Child About HIV and AIDS
Talking about HIV and AIDS means talking about sexual behaviors - and
it's not always easy for parents to talk about sexual feelings and
behavior to their teens. Similarly, it's not always easy for teens to open
up or to believe that issues like HIV and AIDS can affect them.
Doctors and counselors suggest that parents become knowledgeable and
comfortable discussing sex and other difficult issues early on, even
before the teen years. After all, the issues involved - understanding the
body and sexuality, adopting healthy behaviors, respecting others, and
dealing with feelings - are topics that have meaning at all ages (though
how parents talk with their children will vary according to the child's
age and ability to understand). Open communication and good listening
skills are vital for parents and children.
Schools can help. Every state requires schools to provide
age-appropriate information about HIV/AIDS that has been designed to educate
children about the disease. Studies show that such education makes a
tremendous difference in stopping risk-taking behavior by young people.
Parents who are well informed about how to prevent HIV and who talk
with their children regularly about healthy behaviors, feelings, and
sexuality play an important part in HIV/AIDS prevention.
Reviewed by: Adebisi Adeniran Ayokunle
Date reviewed: March 2005
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