Pediatric HIV Infection Differential Diagnoses

Updated: Nov 11, 2020
  • Author: Delia M Rivera, MD; Chief Editor: Russell W Steele, MD  more...
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Diagnostic Considerations

Older children and young teenagers can have human immunodeficiency virus (HIV) infection or AIDS without a history of immunodeficiency or severe illness. Fever of unknown origin, recurrent infection, growth failure, or developmental regression without an obvious etiology should increase the index of suspicion for HIV infection.

The failure to complete neonatal testing is another pitfall. The process to verity that an at-risk neonate does not have HIV infection is complex. Too often, follow-up tests are not performed if initial results are negative.

Prenatal HIV tests are often performed, but the results may not be followed up, especially in low-risk women.

Nonopportunistic infections

Like most children, children with HIV are susceptible to common pathogens. Diseases caused by such pathogens should be high in the list of differential diagnoses for these children. Of course, the particular child's medical history guides the differential diagnosis. For example, chronic lung disease requires special consideration of atypical respiratory pathogens, such as Pseudomonas or Xanthomonas species.

One of the challenges with children who are infected with HIV is that they are more likely than others to have recurrent infections, which cause them to undergo repeat treatment with many broad-spectrum antibiotics. This antibiotic exposure increases the risk of their developing resistant pathogens. Therefore, infection with penicillin-resistant pneumococci is not uncommon in children with recurrent ear infections.

Common recurrent infections are otitis, sinusitis, and pneumonia. Recurrent otitis is observed in 55% and 35% of HIV-infected children with AIDS and those without AIDS, respectively.

Children with recurrent bacterial infections and CD4+ counts of less than 200 X 109/L may benefit from monthly IVIG.

Moderate and severe neutropenia increases the risk for bacterial infection by 2.3- and 7.9-fold, respectively. Other risk factors for bacterial infection include neutropenia within the last 3 months and central venous line access.

Differential Diagnoses