eMedicine Specialties > Dermatology > Viral Infections

Childhood HIV Disease: Treatment & Medication

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

Treatment

Medical Care

Appropriate antiretroviral therapy and treatment of specific infections and malignancies are critical in treating patients who are HIV positive. Intervening early may prevent damage to the immune system and potentially retard infection dissemination. The reverse transcriptase inhibitors are composed of the dideoxynucleosides and the nonnucleoside reverse transcriptase inhibitors (NRTIs). By inhibiting viral reverse transcriptase, HIV replication is suppressed. Protease inhibitors (PIs) prevent the late stages of viral replication by interfering with the formation of structural proteins of the virion core. Combination antiretroviral therapy is recommended for all infants, children, and adolescents.

The following are the 2006 Working Group goals for treating pediatric patients with HIV infection:  

  • Reducing HIV-related mortality and morbidity
  • Restoring and preserving immune function
  • Maximally and durably suppressing viral replication
  • Minimizing drug-related toxicity
  • Maintaining normal physical growth and neurocognitive development
  • Improving quality of life

The following are several important factors to consider in making treatment decisions about when to initiate antiretroviral therapy:

  • Severity of HIV disease
  • Risk of disease progression
  • Laboratory assessments (eg, CD4+ count, plasma HIV RNA levels)
  • Availability of appropriate and palatable drug formulations
  • Adverse effects of the antiretroviral medications
  • Effect of initial treatment regimen choice on later therapeutic options
  • Presence of comorbidities that may affect drug choices
  • Potential antiretroviral drug interactions with required concomitant medications
  • Ability of the child and caregiver to adhere to treatment regimen

A high prevalence of infections, such as candidiasis and varicella-zoster virus infection, must be anticipated, and appropriate prevention and treatment strategies must be initiated.

As the disease progresses, wasting is noted, with weight loss and growth retardation in children. Low protein stores can be countered by increasing the intake of amino acids, specifically threonine and methionine.

Address abnormalities in psychological and neurologic development, due, in part, to the tropism of the virus for CNS tissue in children who are HIV positive.

Surgical Care

Surgical intervention is needed if an underlying neoplasm exists or intervention (eg, feeding tube) is indicated.

Consultations

  • Consult a pediatric HIV specialist to assist in the treatment of children with HIV disease.
  • Appropriate specialty referrals for evaluation are warranted and include an audiologist, an ophthalmologist, a dentist, and a neurodevelopmental specialist (see Other Tests).

Diet

  • Initiate oral supplementation with increased energy intake as high as 150% of the US recommended daily allowance for calories and protein when nutritional deficits are identified.
  • If necessary, enteral supplementation with tube feedings may be warranted.
  • Pay special attention to protein deficits.
  • Some studies have shown that appetite stimulants, such as megestrol acetate and human recombinant growth hormone, can improve growth and weight.

Medication

The Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children established treatment recommendations categorized by age.

Children younger than 12 months

The group recommends initiating antiretroviral treatment in all infants younger than 12 months who have clinical or immunologic symptoms of HIV infection, regardless of HIV RNA level. It also recommends therapy in asymptomatic infants younger than 12 months with a CD4 count of less than 25%. It recommends considering therapy in those younger than 12 months who are asymptomatic with a normal immune status.

Children aged 1-4 years

The Working Group recommends treating all children aged 1-4 years who have AIDS or significant HIV-related symptoms and for patients who are asymptomatic or have mild symptoms and a CD4 of less than 20%. It recommends considering treatment in patients who are asymptomatic or have mild symptoms and CD4 levels of 20-24% or with HIV RNA levels greater than or equal to 100,000 copies/mL. It recommends deferring treatment in asymptomatic patients and in those with CD4 counts greater than 25% and HIV RNA levels less than or equal to 100,000 copies/mL.

Children aged 4-12 years

The Working Group recommends treating all children age 4-12 years who have AIDS or significant HIV-related symptoms and for patients who are asymptomatic or have mild symptoms and a CD4 level of less than 15%. It recommends considering treatment in patients who are asymptomatic or have mild symptoms and CD4 levels of 15-24% or with HIV RNA levels greater than or equal to 100,000 copies/mL. It recommends deferring treatment in asymptomatic patients and in those with CD4 levels greater than 25% and HIV RNA levels less than or equal to 100,000 copies/mL.

Children 13 years or older

The Working Group recommends treating all children older than 13 years who have AIDS or significant HIV-related symptoms and for patients who are asymptomatic or have mild symptoms and a CD4 count less than 200 cells/m L. It recommends considering treatment in patients who are asymptomatic or have mild symptoms and CD4 counts of 201-350 cells/m L or with HIV RNA levels greater than or equal to 100,000 copies/mL. It recommends deferring treatment in asymptomatic patients and in those with CD4 counts greater than 350 cells/m L and HIV RNA levels less than or equal to 100,000 copies/mL.

Some pediatric HIV experts recommend that all children younger than 1 year be treated empirically, even if they are considered to be immunocompetent. Other specialists believe that treatment should be postponed until the immune status deteriorates or CD4+ counts decrease. Given that the risk of disease progression is slower in children older than 1 year, treatment deferment may be considered for older children. Although in adults the goal of therapy is to achieve undetectable levels of HIV RNA, in children only a reduction in the numbers of HIV RNA copies may be seen.

When treating older children, some advocate considering a child's Tanner stage when determining dosing regimens. Adolescents in early puberty (Tanner stages I and II) should be treated according to pediatric dosing guidelines. Adolescents in late puberty (Tanner stage IV) and postpubertal adolescents should follow adult dosing guidelines.

The 2006 Working Group generally preferred recommendation for children includes a combination antiretroviral regimen in previously untreated children with 1 non-NRTI (NNRTI) or 1 PI combined with a 2-drug NRTI combination. It recommends using a 3-drug NRTI regimen only when an NNRTI or a PI cannot be used.

For children younger than 3 years or for children who cannot swallow tablets, the preferred NNRTI-based treatment recommendations include 2 NRTIs plus nevirapine. For children 3 years and older, it is 2 NRTIs plus efavirenz. Nevirapine may be used as an alternative for efavirenz for children  3 years or older.

The preferred PI-based regimen for children is 2 NRTIs plus lopinavir/ritonavir. The alternate recommendation for children older than 2 years is 2 NRTIs plus nelfinavir.

Currently, no nucleoside analogue–based regimen is strongly recommended. Two-drug NRTI regimens may be used in combination with additional agents. The preferred combination is zidovudine plus lamivudine, didanosine, or emtricitabine. A second preferred combination is didanosine plus lamivudine or emtricitabine. An alternative nucleoside analogue–based regimen is abacavir plus zidovudine, lamivudine, emtricitabine, or stavudine.

The following antiretroviral regimens are generally not recommended and should only be considered in unique exceptions: monotherapy, 2 NRTIs alone, tenofovir plus abacavir plus lamivudine or emtricitabine as a triple-NRTI regimen, tenofovir plus didanosine plus lamivudine or emtricitabine as a triple-NRTI regimen.

Several considerations have been established to guide clinicians regarding when to make changes in an antiretroviral regimen. Virologic considerations include inadequate response after 8-12 weeks or unsuppressed HIV RNA levels after 4-6 months. Viral rebound is another virologic consideration for changing antiretroviral therapy, as is demonstrated by (1) repeated detection of HIV RNA levels of greater than 400 copies/mL when previously undetectable or (2) a greater than 3-fold increase in HIV RNA copy number for children 2 years or older or a greater than 5-fold increase for children younger than 2 years.

Immunologic considerations that warrant a change in antiretrovirals includes a change in immunologic classification, persistent CD4+ declines, or a rapid decrease in absolute CD4+ T-cell  count.

Incomplete immunologic response to therapy is likely in children with severe immune suppression who have not improved their CD4 percentage by at least 5 percentage points. The 2006 Working Group also classifies children aged 4-6 years who do not increase their CD4 count by 50 cell/m L above baseline as incomplete immunologic responders. The Working Group also states that  a persistent immunologic decline of 5 percentage points or decline to below pretreatment CD4 absolute counts in children aged 4-6 years may also warrant an antiretroviral therapy change.

Clinical considerations include neurodevelopmental deterioration, growth failure, severe or recurrent infection or illness, and an adverse change in clinical category status.

Other drugs, as appropriate for specific infections or malignancies, are required. More specifically, P carinii pneumonia prophylaxis is recommended in patients who are HIV positive and younger than 1 year and in older children based on CD4+ counts.

Antiretroviral agents

These agents inhibit reverse transcriptase, thereby causing chain termination when incorporated into a growing viral strand.


Zidovudine (AZT, Retrovir)

Thymidine analog that inhibits viral replication. Inhibits activity of HIV reverse transcriptase by competing with natural substrate for use by and incorporation into viral DNA.

Adult

Pediatric

Neonate: 2 mg/kg PO q6h
3 months to 12 years: 180 mg/m2 PO q6h; not to exceed 200 mg q6h
If neonates cannot tolerate PO administration, IV medication can be instituted at 1.5 mg/kg over 30 min q6h

Acetaminophen may decrease bioavailability; toxicity increases when administered concurrently with amphotericin B, flucytosine, interferon alfa, doxorubicin, vincristine, vinblastine, dapsone, cimetidine, indomethacin, probenecid, lorazepam, aspirin, acyclovir, ganciclovir, and pentamidine; fluctuations in levels are associated with coadministration of phenytoin, methadone, fluconazole, atovaquone, valproic acid, lamivudine, and rifampin

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Anemia and granulocytopenia have been reported, especially in advanced HIV disease, necessitating discontinuation and/or transfusions in some patients; caution in bone marrow suppression (eg, granulocyte count <1000 cells/m L or hemoglobin levels <9.5 g/dL); lactic acidosis and severe hepatomegaly with steatosis have been noted; caution in hepatobiliary disease; headache, insomnia, myalgia, myopathy, arthralgia, anxiety, adverse GI tract effects, cough, dyspnea, and changes in skin pigmentation have been reported; adjust dose in renal impairment


Didanosine (Videx)

Synthetic nucleoside analog of deoxyadenosine. Inhibits activity of HIV reverse transcriptase by competing with the natural substrate for use by and incorporation into viral DNA.

Avoid coadministration with other drugs causing pancreatitis; history of neuropathy or use of neurotoxic drugs can increase risk of neuropathy; coadministration with allopurinol not advised because of increase in levels of didanosine; antacids can affect drug levels; may alter absorption of ketoconazole, itraconazole (because of gastric pH changes), ganciclovir, quinolone antibiotics, delavirdine, and indinavir

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Fatal and nonfatal pancreatitis have occurred; discontinue therapy in patients with pancreatitis; lactic acidosis, hepatomegaly with steatosis, retinal depigmentation, and optic neuritis have been reported


Lamivudine (Epivir)

Thymidine analog that inhibits viral replication by way of DNA-chain termination after the nucleoside analog is incorporated.

Adult

Pediatric

3 months to 16 years: 4 mg/kg PO bid; not to exceed 150 mg bid

Bioavailability increases with coadministration of trimethoprim and sulfamethoxazole; lamivudine increases concentration of zidovudine when administered concurrently

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Adjust dose in renal impairment; caution in history of pancreatitis; lactic acidosis and life-threatening hepatomegaly with steatosis have been reported; recurrent hepatitis may be experienced in patients with HIV and hepatitis B–induced liver disease upon cessation of lamivudine


Stavudine (Zerit)

Nucleoside analog of thymidine that inhibits activity of HIV reverse transcriptase.

Adult

Pediatric

<30 kg: 1 mg/kg/dose PO q12h
30-60 kg: 30 mg PO bid
>60 kg: 40 mg PO bid

Zidovudine coadministration can inhibit intracellular phosphorylation of stavudine

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Modify dose in patients with reduced CrCl; severe hepatomegaly, lactic acidosis, and peripheral neuropathy have been reported


Nevirapine (Viramune)

Binds to reverse transcriptase. The RNA- and DNA-dependent DNA polymerase functions are blocked because of a disruption of the catalytic site of the enzyme.

Adult

Pediatric

2 months to 8 years: 4 mg/kg PO qd for 14 d, then 7 mg/kg PO bid
>8 years: 4 mg/kg PO qd for 14 d, then 4 mg/kg PO bid; not to exceed 400 mg/d

Trough plasma concentration increases with coadministration of cimetidine and macrolides; trough concentration decreases with coadministration of rifabutin or rifampin; levels are increased with ketoconazole coadministration; closely monitor levels of drugs metabolized by CYP3A because nevirapine is a CYP3A inducer

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Life-threatening skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, may occur; hepatic necrosis has been reported


Nelfinavir (Viracept)

Inhibits HIV-1 protease, resulting in the production of an immature and noninfectious virus.

Adult

Pediatric

<2 years: Not established
2-13 years: 20-30 mg/kg/dose PO tid with meals

Increases blood concentrations of astemizole (recalled from US market), cisapride, midazolam, isoniazid, stavudine, trimethoprim, terfenadine (recalled from US market), triazolam, and oral contraceptives; fluconazole and rifampin decrease blood concentrations; quinidine and ketoconazole increase blood concentrations; decreases blood concentrations of lamivudine; do not use with lovastatin or simvastatin because of CYP3A4 pathway inhibition and risk of myopathy; caution with sildenafil coadministration because of increased sildenafil concentrations; suboptimal levels of nelfinavir occur with St. John's wort; inhibitor of CYP3A and close monitoring of levels of nelfinavir and drugs metabolized by the CYP3A system advised when administered concomitantly

Documented hypersensitivity; concurrent use of cisapride, triazolam, midazolam, ergot derivatives, amiodarone, or quinidine because of altered hepatic metabolism

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in hepatic impairment; increase in bleeding in patients with hemophilia has been reported; lipodystrophy and diabetes mellitus have been reported


Ritonavir (Norvir)

HIV PI used as a part of a double or triple therapy with nucleosides and other PIs. Inhibition of the protease thwarts the gag-pol polyprotein cleavage, which results in a noninfectious virus.

Adult

Pediatric

400 mg/m2 PO bid; not to exceed 600 mg bid

Coadministration with propoxyphene, quinidine, amiodarone, bupropion, cisapride, clozapine, encainide, astemizole (recalled from US market), bepridil, flecainide, meperidine, rifabutin, piroxicam, propafenone, or terfenadine (recalled from US market) may cause arrhythmias, hematologic abnormalities, and seizures; coadministration with alprazolam, clorazepate, diazepam, estazolam, flurazepam, midazolam, triazolam, or zolpidem may significantly increase toxicity; do not use with lovastatin or simvastatin because of CYP3A4 pathway inhibition and risk of myopathy; caution with sildenafil coadministration because of increased sildenafil concentrations; suboptimal levels of ritonavir with St. John's wort reported; inhibitor of CYP3A and close monitoring of levels of ritonavir and drugs metabolized by CYP3A system is advised when administered concomitantly

Documented hypersensitivity; concomitant administration with cisapride, triazolam, midazolam, ergot derivatives, amiodarone, quinidine, bepridil, flecainide, propafenone, and pimozide because of altered hepatic metabolism

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in hepatic insufficiency and antiarrhythmic treatments; increased bleeding in hemophilia, lipodystrophy, increased triglyceride and cholesterol levels, and diabetes mellitus have been reported


Emtricitabine (Emtriva)

Synthetic nucleoside cytosine analog classified as NRTI. Competes with deoxycytidine-5'-triphosphate and incorporates into viral DNA, causing chain termination. Not recommended as monotherapy.

Adult

200 mg PO qd

Pediatric

Cap and sol not bioequivalent
<3 months: 3 mg/kg sol PO qd
3 months to 17 years: 6 mg/kg sol PO qd; alternatively, 200 mg PO qd if patient can swallow cap and is >33 kg
Not to exceed 240 mg/d for sol

Concomitant use with ribavirin (with or without interferon alfa) or nucleoside analogs may increase toxicity, resulting in pancreatitis or lactic acidosis

Documented hypersensitivity to drug, class, or component

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Common adverse effects include headache, diarrhea, nausea, rash, rhinitis, asthenia, cough, abdominal pain, hypertriglyceridemia, depression, insomnia, dyspepsia, paresthesias, myalgia, arthralgia, palmar-plantar hyperpigmentation, and elevated CK level; reduce dose for CrCl <50 mL/min; serious or fatal pancreatitis and lactic acidosis reported; may cause hyperpigmentation on soles or palms; may cause fat redistribution; additional serious reactions include hepatomegaly with steatosis, hepatotoxicity, neutropenia, and immune reconstitution syndrome
Caution in impaired liver disease, long-term nucleoside treatment, or hepatitis B co-infection (may cause hepatitis B exacerbation posttreatment); breastfeeding not recommended


Efavirenz (Sustiva)

NNRTI with activity against HIV-1 by binding to reverse transcriptase. Blocks RNA- and DNA-dependent DNA polymerase activities, including HIV-1 replication. Does not require intracellular phosphorylation for antiviral activity.

Adult

600 mg PO qhs on empty stomach

Pediatric

<3 years: Not established
>3 years
10-15 kg: 200 mg PO qhs on empty stomach
15-20 kg: 250 mg PO qhs on empty stomach
20-25 kg: 300 mg PO qhs on empty stomach
25-32.5 kg: 350 mg PO qhs on empty stomach
32.5-40 kg: 400 mg PO qhs on empty stomach
>40 kg: 600 mg PO qhs on empty stomach

Increases toxicity of cisapride, midazolam, triazolam, and ergot alkaloids, resulting in life-threatening toxicities; may increase effect of warfarin; may increase levels of CYP2C9, including bosentan, dapsone, fluoxetine, glimepiride, glipizide, losartan, montelukast, paclitaxel, phenytoin, or zafirlukast; may increase levels of CYP2C19, including citalopram, diazepam, phenytoin, propranolol, and sertraline
CYP2B6 inducers that may decrease levels include carbamazepine, phenobarbital, phenytoin, and rifampin; may reduce concentrations of atazanavir, indinavir, lopinavir, saquinavir, methadone, or sertraline

Documented hypersensitivity to drug, class, or component; coadministration with astemizole, cisapride, midazolam, triazolam, or ergot derivatives

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in psychiatric illness, impaired liver function, hepatitis, or seizure history; unsafe during breastfeeding
Serious adverse effects include Stevens-Johnson syndrome, erythema multiforme, exfoliative dermatitis, depression (possibly severe), suicidality, psychiatric disorders, fat redistribution, immune reconstitution syndrome, hepatotoxicity, pancreatitis, seizures, and teratogenicity (first trimester)
Other adverse effects include rash, anxiety, depression, nervousness, drowsiness, impaired concentration, insomnia, abnormal dreams, hyperlipidemia, elevated liver transaminase levels, diarrhea, nausea, and fever


Abacavir (Ziagen)

NRTI that interferes with HIV viral RNA-dependent DNA polymerase and inhibits viral replication.

Adult

300 mg PO qd; alternatively, 600 mg PO qd.

Pediatric

<3 months: Not established
3 months to 16 years: 16 mg/kg/d PO divided bid, not to exceed 600 mg/d
>16 years: 300 mg PO bid; alternatively, 600 mg PO qd

Ethanol may increase risk of toxicity; methadone concentrations may decrease with concomitant administration; concomitant use of ribavirin with or without interferon alfa may cause lactic acidosis or pancreatitis

Documented hypersensitivity to drug, class, or component; breastfeeding not recommended

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Fatal hypersensitivity may occur following reintroduction of therapy; caution in hepatic dysfunction, prior liver disease, and prolonged use
Serious adverse effects include liver failure, renal failure, severe hypotension, ARDS, respiratory failure, death, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, lactic acidosis, hepatomegaly with steatosis, fat redistribution, pancreatitis, and immune reconstitution syndrome
Other adverse effects include nausea, headache, fatigue, vomiting, hypersensitivity, diarrhea, fever/chills, depression, rash, anxiety, URI, elevated liver transaminase levels, and hypertriglyceridemia


Tenofovir (Viread)

Antiretroviral agent used in the treatment of AIDS. Inhibits activity of HIV reverse transcriptase by competing with the natural substrate deoxyadenosine 5'-triphosphate and, after incorporation into DNA, by DNA chain termination. Administered as prodrug bis -isopropoxycarbonyloxymethyl ester derivative of tenofovir, which is converted, through various enzymatic processes, to tenofovir, an acyclic nucleoside phosphonate (nucleotide) analog of adenosine 5'-monophosphate.
Bioavailability enhanced by a high-fat meal. Prolonged intracellular distribution allows for once-daily dosing.

Adult

300 mg PO qd; adjust dosing frequency in renal insufficiency (ie, CrCl 30-49 mL/min, give q48h; CrCl 10-29 mL/min, give twice weekly; CrCl <10 mL/min, no recommendations; hemodialysis, give q7d after hemodialysis)

Pediatric

Not established

Coadministration with drugs eliminated by active tubular secretion in kidney may increase serum concentrations of either tenofovir or coadministered drug; drugs that decrease renal function (eg, acyclovir, ganciclovir, cidofovir) may increase serum concentrations of tenofovir

Documented hypersensitivity to drug, class, or component

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Serious adverse effects include lactic acidosis, hepatomegaly with steatosis, hepatotoxicity, nephrotoxicity, renal failure, hypophosphatemia pancreatitis, fractures, dyspnea, allergic reaction, fat redistribution, Fanconi syndrome, renal tubular necrosis (acute), hepatitis B exacerbation (posttreatment), and immune reconstitution syndrome
Other adverse effects include rash, hypercholesterolemia, headache, elevated CK level, pain, diarrhea, depression, elevated amylase levels, back pain, fever, nausea/vomiting, abdominal pain, hematuria, asthenia, anxiety, arthralgia/myalgia, insomnia, pneumonia, dyspepsia, dizziness, and elevated liver transaminase levels

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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