eMedicine Specialties > Dermatology > Viral Infections

Childhood HIV Disease: Differential Diagnoses & Workup

Author: Mark Abdelmalek, MD, Chief, Division of Laser and Dermatologic Surgery, Assistant Professor, Department of Dermatology, Drexel University College of Medicine
Coauthor(s): Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center; Kathleen B Elmer, MD, Consulting Staff, Department of Dermatology, First Medical Group, Langley Air Force Base
Contributor Information and Disclosures

Updated: Jul 15, 2008

Differential Diagnoses

Actinomycosis
Herpes Simplex
Aspergillosis
Herpes Zoster
Atopic Dermatitis
Leiomyoma
Bacillary Angiomatosis
Lice
Bacterial Mouth Infections
Lymphogranuloma Venereum
Cancers of the Oral Mucosa
Molluscum Contagiosum
Chancroid
Noncandidal Fungal Infections of the Mouth
Chickenpox
Onychomycosis
Chronic Granulomatous Disease
Oral Manifestations of Drug Reactions
Coccidioidomycosis
Paronychia
Cutaneous Tuberculosis
Pellagra
Dermatologic Manifestations of Gastrointestinal Disease
Pityrosporum Folliculitis
Dermatologic Manifestations of Hematologic Disease
Pseudomonas Folliculitis
Dermatologic Manifestations of Neurologic Disease
Scabies
Dermatologic Manifestations of Pulmonary Disease
Scurvy
Dermatologic Manifestations of Renal Disease
Seborrheic Dermatitis
DiGeorge Syndrome
Syphilis
Ecthyma
Tinea Barbae
Ecthyma Gangrenosum
Tinea Capitis
Eosinophilic Pustular Folliculitis
Tinea Corporis
Epidermodysplasia Verruciformis
Tinea Cruris
Erythema Annulare Centrifugum
Tinea Faciei
Erythroderma (Generalized Exfoliative Dermatitis)
Tinea Pedis
Eumycetoma (Fungal Mycetoma)
Tinea Versicolor

Workup

Laboratory Studies

  • Prompt diagnosis of HIV infection is critical. As such, the CDC recommends prenatal HIV testing as the standard of care for all pregnant women in the United States. Diagnosis of HIV infection in infants is aided by HIV culture or DNA/RNA PCR; positive results are confirmed by repeating the test. In suspected cases, HIV testing should occur immediately in the newborn period (ie, before the infant is aged 48 h), at age 1-2 months, and again at age 3-6 months. Testing at age 14 days may allow for earlier detection of HIV in infants who had negative test results within the first 48 hours of life. By approximately age 1 month, PCR testing has a 96% sensitivity and 99% specificity to identify HIV.
    • The 2006 Working Group16 recommendations for diagnosing infants are as follows:
      • Because of the persistence of the maternal HIV antibody, infants younger than 18 months require virologic assays that directly detect HIV in order to diagnose HIV infection.
      • Virologic diagnostic testing in infants with known perinatal HIV exposure is recommended at birth to 14 days, at 1–2 months, and at 3–6 months. Preferred virologic assays include HIV DNA PCR and HIV RNA assays.
      • An antibody test to document seroreversion to HIV antibody–negative status in uninfected infants is recommended at age 12–18 months.
      • In children 18 months and older, HIV antibody assays can be used for diagnosis. 
    • The Working Group does not recommend use of the currently approved HIV p24 antigen assay for infant diagnosis in the United States because the sensitivity and specificity of the assay in the first months of life is less than that of other HIV virologic tests.
  • Monitor CD4+ levels or percentages in infants or patients newly diagnosed with HIV at 3- to 4-month intervals to assess patients' immune status. In children younger than 6 years, the 2006 Working Group recommends using CD4 percentages over absolute CD4 counts for monitoring disease progression because of inherent age-related changes in absolute CD4 counts.
  • Monitor for opportunistic infections.
    • Perform a CBC count with differential and a urinalysis every 1-3 months in infants. Older child can be screened every 3-6 months (CBC count) or yearly (urinalysis).
    • Culture urine samples monthly for the presence of cytomegalovirus (CMV) until age 2 months and then at 2-month intervals until age 12 months. 
  • Assess HIV RNA levels twice at baseline and then every 3-4 months. (Consistently use the same HIV RNA assay method to monitor a particular patient.) More frequent testing of HIV RNA levels and CD4 counts may be necessary for children who have virologic or clinical deterioration or when initiating or changing antiretroviral therapy.
  • If the mother is HIV positive, use serologic tests to screen the infant for hepatitis B, hepatitis C, syphilis, and toxoplasmosis.
  • Decreased levels of albumin, serum immunoglobulin G, and CD8+ T cells are linked with fatality in children.
  • Monitor laboratory studies in accordance with drug therapy protocols and clinical status (eg, lipid profile in a patient with lipodystrophy).

Imaging Studies

  • Perform chest radiography, CT scanning, MRI, echocardiography, and ECG for baseline determinations and subsequently as clinically indicated.

Other Tests

  • Perform history and physical examinations at regular intervals (eg, every 2 wk initially in infancy, with an increase in intervals as the child ages and the immune status stabilizes).
  • Obtain an audiologic evaluation at age 2 years or sooner if concern exists.
  • Obtain dental examinations at age 1-2 years.
  • Obtain a neurodevelopmental evaluation every 3-6 months.
  • Obtain an ophthalmologic evaluation for CMV, tuberculosis, and toxoplasmosis infections, as well as for corneal ulceration, which is often secondary to underlying nutritional deficits.
  • Obtain a cerebrospinal fluid analysis in patients with neurologic disease (based on risk factors of the area and the clinical presentation of the child).

Procedures

  • Perform endoscopy when esophageal candidiasis is suggested.
  • Perform a Mantoux test for tuberculosis at age 6 months. (Test patients with control skin tests [eg, tetanus, mumps] to ensure absence of anergy.)
  • Isolation of acid-fast bacteria in patients in whom pulmonary infection is suggested may be attempted with gastric lavage; it is sensitive in 32% and 48.8% of cases of pulmonary meningitis and tubercular meningitis, respectively.

Histologic Findings

Biopsy may be considered to clearly determine the presence of an infectious or malignant cutaneous lesion. Maintain a high index of suspicion for a wide array of infections and malignancies, and the appropriate staining and tissue preparation should be requested.

Staging

  • Clinical categories are based on the 1998 CDC guidelines17 for antiretroviral treatment of pediatric AIDS (review and modification of the 1994 CDC HIV pediatric classification system for clinical categories in children younger than 13 y).
    • Category N: Children are asymptomatic. No signs or symptoms attributed to HIV infection are present, or patients have only 1 category A disorder.
    • Category A: Children are mildly symptomatic. Patients have 2 or more of the following conditions but no category B or C condition:
      • Lymphadenopathy (³ 0.5 cm at more than 2 sites; bilateral = 1 site [ie, at the same anatomical location bilaterally])
      • Hepatomegaly
      • Splenomegaly
      • Dermatitis
      • Parotitis
      • Recurrent or persistent upper respiratory tract infection, sinusitis, or otitis media
    • Category B: Children are moderately symptomatic. Patients have symptomatic conditions not in category A or category C but that result from HIV infection. Some category B disorders are as follows:
      • Anemia (<8 g/dL), neutropenia (<1000/m L), or thrombocytopenia (<100,000/m L) persisting longer than 30 days
      • Bacterial meningitis, pneumonia, or sepsis (single episode)
      • Candidiasis, oropharyngeal (ie, thrush), persisting for longer than 2 months in children aged 6 months
      • Cardiomyopathy
      • CMV infection with onset before age 1 month
      • Diarrhea (recurrent or chronic)
      • Hepatitis
      • HSV stomatitis (recurrent, ie, >2 episodes within 1 y)
      • HSV bronchitis, pneumonitis, or esophagitis with onset before age 1 month
      • Herpes zoster (ie, shingles) involving at least 2 distinct episodes or more than 1 dermatome
      • Leiomyosarcoma
      • Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex
      • Nephropathy
      • Nocardiosis
      • Fever lasting 1 month
      • Toxoplasmosis with onset before age 1 month
      • Varicella (disseminated, ie, complicated chickenpox
    • Category C: Patients are severely symptomatic. Patients have any condition listed in the 1987 surveillance case definition for AIDS, except for lymphoid interstitial pneumonia, which is now considered a category B condition.
  • Immunologic categories with CD4+ T cell counts and percentages (based on CDC 1994 revised HIV pediatric classification system) are as follows:
    • Patients younger than 12 months
      • Nonsuppressed (category 1) - CD4+ count greater than 1500 cells/m L (³ 25%)
      • Moderate suppression (category 2) - CD4+ count equal to 750-1499 cells/m L (15-24%)
      • Severe suppression (category 3) - CD4+ count less than 750 cells/m L (<15%)
    • Patients aged 1-5 years
      • Nonsuppressed (category 1) - CD4+ greater than or equal to 1000 cells/m L (³ 25%)
      • Moderate suppression (category 2) - CD4+ count equal to 500-999 cells/m L (15-24%)
      • Severe suppression (category 3) - CD4+ less than 500 cells/m L ( £ 15%)
    • Patients aged 6-12 years
      • Nonsuppressed (category 1) - CD4+ count greater than 500 cells/m L (³ 25%)
      • Moderate suppression (category 2) - CD4+ equal to 200-499 cells/m L (15-24%)
      • Severe suppression (category 3) - CD4+ less than 200 cells/m L (<15%)

More on Childhood HIV Disease

Overview: Childhood HIV Disease
Differential Diagnoses & Workup: Childhood HIV Disease
Treatment & Medication: Childhood HIV Disease
Follow-up: Childhood HIV Disease
References
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References

  1. World Health Organization. Paediatric HIV and treatment of children living with HIV. Available at http://www.who.int/hiv/paediatric/en/index.html. Accessed 2006.

  2. Garrib A, Jaffar S, Knight S, Bradshaw D, Bennish ML. Rates and causes of child mortality in an area of high HIV prevalence in rural South Africa. Tropical Medicine and International Health. Dec 2006;11 (12):1841-1848. [Medline].

  3. Chiou CC, Groll AH, Gonzalez CE, Callender D, Venzon D, Pizzo PA, et al. Esophageal candidiasis in pediatric acquired immunodeficiency syndrome: clinical manifestations and risk factors. Pediatr Infect Dis J. Aug 2000;19(8):729-34. [Medline].

  4. Brown DM, Jabra-Rizk MA, Falkler WA, Baqui AA, Meiller TF. Identification of Candida dubliniensis in a study of HIV-seropositive pediatric dental patients. Pediatr Dent. May-Jun 2000;22(3):234-8. [Medline].

  5. Pongsiriwet S, Iamaroon A, Kanjanavanit S, Pattanaporn K, Krisanaprakornkit S. Oral lesions and dental caries status in perinatally HIV-infected children in Northern Thailand. Int J Paediatr Dent. May 2003;13(3):180-5. [Medline].

  6. Tofsky N, Nelson EM, Lopez RN, Catalanotto FA, Fine DH, Katz RV. Dental caries in HIV-infected children versus household peers: two-year findings. Pediatr Dent. May-Jun 2000;22(3):207-14. [Medline].

  7. Dias EP, Israel MS, Silva Junior A, Maciel VA, Gagliardi JP, Oliveira RH. Prevalence of oral hairy leukoplakia in 120 pediatric patients infected with HIV-1. Braz Oral Res. Apr-Jun 2006;20(2):103-7. [Medline].

  8. Mohle-Boetani JC, Koehler JE, Berger TG, LeBoit PE, Kemper CA, Reingold AL, et al. Bacillary angiomatosis and bacillary peliosis in patients infected with human immunodeficiency virus: clinical characteristics in a case-control study. Clin Infect Dis. May 1996;22(5):794-800. [Medline].

  9. Perry RT, Mmiro F, Ndugwa C, Semba RD. Measles infection in HIV-infected African infants. Ann N Y Acad Sci. Nov 2000;918:377-80. [Medline].

  10. Enwonwu CO, Falkler WA Jr, Idigbe EO, Savage KO. Noma (cancrum oris): questions and answers. Oral Dis. Apr 1999;5(2):144-9. [Medline].

  11. Jaquet D, Levine M, Ortega-Rodriguez E, Faye A, Polak M, Vilmer E, et al. Clinical and metabolic presentation of the lipodystrophic syndrome in HIV-infected children. AIDS. Sep 29 2000;14(14):2123-8. [Medline].

  12. Chiarelli F, Galli L, Verrotti A, di Ricco L, Vierucci A, de Martino M. Thyroid function in children with perinatal human immunodeficiency virus type 1 infection. Thyroid. Jun 2000;10(6):499-505. [Medline].

  13. Smith KJ, Skelton HG 3rd, Vogel P, Yeager J, Baxter D, Wagner KF. Exaggerated insect bite reactions in patients positive for HIV. Military Medical Consortium for the Advancement of Retroviral Research. J Am Acad Dermatol. Aug 1993;29(2 Pt 1):269-72. [Medline].

  14. Kest H, Brogly S, McSherry G, Dashefsky B, Oleske J, Seage GR. Malignancy in perinatally human immunodeficiency virus-infected children in the United States. Pediatr Infect Dis J. Mar 2005;24(3):237-42. [Medline].

  15. Ziegler JL, Katongole-Mbidde E. Kaposi's sarcoma in childhood: an analysis of 100 cases from Uganda and relationship to HIV infection. Int J Cancer. Jan 17 1996;65(2):200-3. [Medline].

  16. Working Group on Antiretroviral Therapy and Medical Management of HIV infected C, Health Resources and Services Administration. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. National Institutes of Health. Available at http://aidsinfo.nih.gov/ContentFiles/PediatricGuidelines.pdf. Accessed 2006.

  17. Center for Disease Control and Prevention. Guidelines for the use of antiretroviral agents in pediatric HIV infection. MMWR Recomm Rep. Apr 17 1998;47(RR-4):1-43. [Medline].

  18. Benjamin DK Jr, Miller WC, Benjamin DK, Ryder RW, Weber DJ, Walter E, et al. A comparison of height and weight velocity as a part of the composite endpoint in pediatric HIV. AIDS. Nov 7 2003;17(16):2331-6. [Medline].

  19. Barasch A, Safford MM, Catalanotto FA, Fine DH, Katz RV. Oral soft tissue manifestations in HIV-positive vs. HIV-negative children from an inner city population: a two-year observational study. Pediatr Dent. May-Jun 2000;22(3):215-20. [Medline].

  20. Benakappa A, Benakappa N, Benakappa DG. Management of tuberculosis. Indian J Pediatr. Sep-Oct 1995;62(5):557-63. [Medline].

  21. Blanche S, Tovo PA. European epidemiology. In: Pizzo PA, Wilfert CM. Pediatric AIDS: The Challenge of HIV Infection in Infants, Children, and Adolescents. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998:13-22.

  22. Bohler T, Wintergerst U, Linde R, Belohradsky BH, Debatin KM. CD95 (APO-1/Fas) expression on naive CD4(+) T cells increases with disease progression in HIV-infected children and adolescents: effect of highly active antiretroviral therapy (HAART). Pediatr Res. Jan 2001;49(1):101-10. [Medline].

  23. Capaldini L. Psychosocial issues and psychiatric complications of HIV disease. In: Sande MA, Volberding PA. The Medical Management of AIDS. 6th ed. Philadelphia, Pa: WB Saunders; 1999:241-63.

  24. Caselli D, Klersy C, de Martino M, Gabiano C, Galli L, Tovo PA, et al. Human immunodeficiency virus-related cancer in children: incidence and treatment outcome--report of the Italian Register. J Clin Oncol. Nov 15 2000;18(22):3854-61. [Medline].

  25. Centers for Disease Control and Prevention. 1994 Revised classification system for human immunodeficiency virusinfection in children less than 13 years of age. MMWR. 1994;43 (No. RR-12):1-10.

  26. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report: HIV Infection and AIDS in the United States and Dependent Areas. Department of Health and Human Services. Available at http://www.cdc.gov/hiv/topics/surveillance/basic.htm.

  27. Centers for Disease Control and Prevention. National Center for HIV, STD and TB prevention: Division of HIV/AIDS Prevention. Department of Health and Human Services. Available at http://www.cdc.gov/hiv/dhap.htm. Accessed 2005.

  28. Centers for Disease Control and Prevention. 1994 revised guidelines for the performance of CD4+ T-cell determinations in persons with human immunodeficiency virus (HIV) infections. MMWR Recomm Rep. Mar 4 1994;43(RR-3):1-21. [Medline].

  29. Chang MW, Orlow SJ. Molluscum contagiosum in children: When and how to treat. Consultant. 1998;1593-1599.

  30. Clerici M, Saresella M, Colombo F, Fossati S, Sala N, Bricalli D, et al. T-lymphocyte maturation abnormalities in uninfected newborns and children with vertical exposure to HIV. Blood. Dec 1 2000;96(12):3866-71. [Medline].

  31. Cohen H, Chen XC, Sunkle S, Davis L, Geromanos K, Xanthos G, et al. Ability of caregivers to read delayed hypersensitivity skin tests in children exposed to and infected by HIV. The Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Study Group. J Pediatr Health Care. Mar-Apr 2000;14(2):50-5. [Medline].

  32. D'Angelo LJ. Sexually transmitted diseases in children and adolescents with HIV infection. In: Pizzo PA, Wilfert CM. Pediatric AIDS: The Challenge of HIV Infection in Infants, Children, and Adolescents. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998:169-182.

  33. Epocrates. Drug Information. Epocrates Online. Available at http://www.epocrates.com/. Accessed 2007.

  34. Gondim LA, Zonta RF, Fortkamp E, Schmeling RO. Otorhinolaryngological manifestations in children with human immunodeficiency virus infection. Int J Pediatr Otorhinolaryngol. Aug 31 2000;54(2-3):97-102. [Medline].

  35. Greenberg AE, Dabis F, Marum LH. HIV infection in Africa. In: Pizzo PA, Wilfert CM. Pediatric AIDS: The Challenge of HIV Infection in Infants, Children, and Adolescents. 3rd ed. Lippincott Williams & Wilkins; 1998::23-46.

  36. Hansen RD, Raja C, Allen BJ. Total body protein in chronic diseases and in aging. Ann N Y Acad Sci. May 2000;904:345-52. [Medline].

  37. Hines SE. Primary care for HIV-exposed and infected children: translating progress into practice. Lippincotts Prim Care Pract. Jan-Feb 2000;4(1):43-65. [Medline].

  38. Howland LC, Gortmaker SL, Mofenson LM, Spino C, Gardner JD, Gorski H, et al. Effects of negative life events on immune suppression in children and youth infected with human immunodeficiency virus type 1. Pediatrics. Sep 2000;106(3):540-6. [Medline].

  39. Joint United Nations Programme on HIV/AIDS. UNAIDS/WHO AIDS Update. Available at www.unaids.org/wad2004/report.html. Accessed 2004.

  40. Joint United Nations Programme on HIV/AIDS. UNAIDS/WHO epidemiological fact sheets on HIV/AIDS and Sexually Transmitted Infections, Update, India. Available at www.unaids.org/wad2004/factsheets.html. Accessed 2004.

  41. Kline MW. Pediatric HIV Infection. Baylor International Pediatric AIDS Initiative--Educational Resources. 2005.

  42. Kovacs A, Scott GB. Advances in the management and care of HIV-positive newborns and infants. In: Pizzo PA, Wilfert CM. Pediatric AIDS: The Challenge of HIV Infection in Infants, Children, and Adolescents. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998:567-92.

  43. Laude TA. Manifestations of HIV disease in children. Clin Dermatol. Jul-Aug 2000;18(4):457-67. [Medline].

  44. Layton TL, Davis-McFarland E. Pediatric human immunodeficiency virus and acquired immunodeficiency syndrome: an overview. Semin Speech Lang. 2000;21(1):7-17. [Medline].

  45. Leandro-Merhi VA, Vilela MM, Silva MN, Lopez FA, Barros Filho A. Evolution of nutritional status of infants infected with the human immunodeficiency virus. Sao Paulo Med J. Sep 7 2000;118(5):148-53. [Medline].

  46. Mastro TD, Zhang KL, Panda S. HIV infection and AIDS in Asia. In: Pizzo PA, Wilfert CM, eds. Pediatric AIDS: The Challenge of HIV Infection in Infants, Children, and Adolescents. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998:47-63.

  47. McIntosh K. Human immunodeficiency virus: the virus and its pathogenicity. In: Yogev R, Connor E. Management of HIV Infection in Infants and Children. Mosby-Year Book; 1992::35-51.

  48. Medical Economics Staff. Physician's Desk Reference. 55th ed. Montvale, NJ: Medical Economics Company; 2001:472-8, 499-503, 1374-7, 1456-60, 2838-42, 3482-7.

  49. Mueller BU. HIV-associated malignancies in children. AIDS Patient Care STDS. Sep 1999;13(9):527-33. [Medline].

  50. Naidoo S, Chikte U. Oro-facial manifestations in paediatric HIV: a comparative study of institutionalized and hospital outpatients. Oral Dis. Jan 2004;10(1):13-8. [Medline].

  51. National Institutes of Health, National Institue of Allergy and Infectious Disease, US Dept of Health and Human Services. HIV Infection in Minority Populations. 2005;[Full Text].

  52. Ndour M, Sow PS, Coll-Seck AM, Badiane S, Ndour CT, Diakhate N, et al. AIDS caused by HIV1 and HIV2 infection: are there clinical differences? Results of AIDS surveillance 1986-97 at Fann Hospital in Dakar, Senegal. Trop Med Int Health. Oct; 2000;5(10):687-91. [Medline].

  53. Padhani DH, Manji KP, Mtanda AT. Ocular manifestations in children with HIV infection in Dar es Salaam, Tanzania. J Trop Pediatr. Jun 2000;46(3):145-8. [Medline].

  54. Penneys NS, ed. Bacterial and complex infections. In: Skin Manifestations of AIDS. 2nd ed. St Louis, Mo: Mosby-Year Book; 1995:50-74.

  55. Portela MB, Souza IP, Costa EM, Hagler AN, Soares RM, Santos AL. Differential recovery of Candida species from subgingival sites in human immunodeficiency virus-positive and healthy children from Rio de Janeiro, Brazil. J Clin Microbiol. Dec 2004;42(12):5925-7. [Medline].

  56. Raju PV, Rao GR, Ramani TV, Vandana S. Skin disease: clinical indicator of immune status in human immunodeficiency virus (HIV) infection. Int J Dermatol. Aug; 2005;44(8):646-9. [Medline].

  57. Ramos-Gomez F. Dental considerations for the paediatric AIDS/HIV patient. Oral Dis. 2002;8 Suppl 2:49-54. [Medline].

  58. Rogers MF, Lindegren ML, Simonds RJ. Pediatric HIV infection in the United States. In: Pizzo PA, Wilfert CM,. Pediatric AIDS: The Challenge of HIV Infection in Infants, Children, and Adolescents. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998:3-11.

  59. Rongkavilit C, Mitchell CD, Nachman S. Varicella zoster infection in HIV-infected children. Paediatr Drugs. Jul-Aug 2000;2(4):291-7. [Medline].

  60. Shearer WT, Easley KA, Goldfarb J, Jenson HB, Rosenblatt HM, Kovacs A, et al. Evaluation of immune survival factors in pediatric HIV-1 infection. Ann N Y Acad Sci. Nov 2000;918:298-312. [Medline].

  61. Smith R, Malee K, Charurat M, Magder L, Mellins C, Macmillan C, et al. Timing of perinatal human immunodeficiency virus type 1 infection and rate of neurodevelopment. The Women and Infant Transmission Study Group. Pediatr Infect Dis J. Sep 2000;19(9):862-71. [Medline].

  62. Solomon BA, Laude TA. A peculiar annular eruption in a child with AIDS. J Am Acad Dermatol. Sep 1995;33(3):513-4. [Medline].

  63. Stefanaki C, Stratigos AJ, Stratigos JD. Skin manifestations of HIV-1 infection in children. Clin Dermatol. Jan-Feb 2002;20(1):74-86. [Medline].

  64. Straka BF, Whitaker DL, Morrison SH, Oleske JM, Grant-Kels JM. Cutaneous manifestations of the acquired immunodeficiency syndrome in children. J Am Acad Dermatol. May 1988;18(5 Pt 1):1089-102. [Medline].

  65. Taha TE, Nour S, Kumwenda NI, Broadhead RL, Fiscus SA, Kafulafula G, et al. Gender differences in perinatal HIV acquisition among African infants. Pediatrics. Feb 2005;115(2):e167-72. [Medline].

  66. Thomas P, Bornschlegel K, Singh TP, Abrams EJ, Cervia J, Fikrig S, et al. Tuberculosis in human immunodeficiency virus-infected and human immunodeficiency virus-exposed children in New York City. The New York City Pediatric Spectrum of HIV Disease Consortium. Pediatr Infect Dis J. Aug 2000;19(8):700-6. [Medline].

  67. UNAIDS, UNICEF, USAID. Children on the Brink 2004: A joint report of new orphan estimates and a framework for action. UNICEF. Available at http://www.unicef.org/publications/index_22212.html. Accessed 2004.

  68. UNAIDS, WHO. UNAIDS/WHO AIDS Epidemic Update:. UNAIDS. Available at http://www.unaids.org/en/HIV_data/epi2006/default.asp. Accessed 2006.

  69. von Seidlein L, Gillette SG, Bryson Y, Frederick T, Mascola L, Church J, et al. Frequent recurrence and persistence of varicella-zoster virus infections in children infected with human immunodeficiency virus type 1. J Pediatr. Jan 1996;128(1):52-7. [Medline].

  70. Weedon D, ed. The spongiotic reaction pattern. In: Skin Pathology. New York, NY: Churchill Livingstone; 1997:83-107.

  71. Weedon D, ed. Mycoses and algal infections. In: Skin Pathology. New York, NY: Churchill Livingstone; 1997:555-582.

  72. Weedon D, ed. Vascular tumors. In: Skin Pathology. New York, NY: Churchill Livingstone; 1997:821-854.

  73. Whitworth JM, Janniger CK, Oleske JM, Schwartz RA. Cutaneous manifestations of childhood acquired immunodeficiency syndrome and human immunodeficiency virus infection. Cutis. Feb 1995;55(2):62-6, 70-2. [Medline].

  74. Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infectioin. Developed by Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children. National Institutes of Health. Available at http://aidsinfo.nih.gov. Accessed 2005.

  75. World Health Organization. The World Health Report: Global Health--today's challenges. Available at http://www.who.int/whr/2003/en/Chapter1.pdf. Accessed 2005.

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Further Reading

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Keywords

pediatric HIV infection, HIV-positive children, cutaneous findings of HIV, human immunodeficiency virus, human immunodeficiency virus type 1, HIV-1, human immunodeficiency virus type 2, HIV-2, acquired immune deficiency syndrome, AIDS, immunocompromise

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Contributor Information and Disclosures

Author

Mark Abdelmalek, MD, Chief, Division of Laser and Dermatologic Surgery, Assistant Professor, Department of Dermatology, Drexel University College of Medicine
Mark Abdelmalek, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Kathleen B Elmer, MD, Consulting Staff, Department of Dermatology, First Medical Group, Langley Air Force Base
Disclosure: Nothing to disclose.

Medical Editor

Robin Travers, MD, Professor, Department of Dermatology, Boston University School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey
Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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