Questions & Answers

Brooks M. Study supports earlier initiation of HAART in HIV-infected children. Medscape Medical News. October 2, 2014. [Full Text].
Yin DE, Warshaw MG, Miller WC, Castro H, Fiscus SA, Harper LM, et al. Using CD4 percentage and age to optimize pediatric antiretroviral therapy initiation. Pediatrics. 2014 Oct. 134(4):e1104-16. [Medline].
[Guideline] The Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the use of antiretroviral agents in pediatric HIV infection. AIDSinfo. Available at https://aidsinfo.nih.gov/. 2017Apr27; Accessed: September 12, 2017.
Prevalence and awareness of HIV infection among men who have sex with men --- 21 cities, United States, 2008. MMWR Morb Mortal Wkly Rep. 2010 Sep 24. 59(37):1201-7. [Medline].
Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths - United States. MMWR Morb Mortal Wkly Rep. 2012 Nov 30. 61(47):971-6. [Medline]. [Full Text].
World Health Organization. Paediatric HIV and treatment of children living with HIV. Available at http://www.who.int/hiv/paediatric/en/index.html. Accessed: June 22, 2011.
World Health Organization. Global summary of the AIDS epidemic: 2009. Available at http://www.who.int/hiv/data/2009_global_summary.png. Accessed: June 21, 2011.
UNAIDS Report on the Global AIDS Epidemic 2010. Available at http://www.unaids.org/globalreport/Global_report.htm. Accessed: June 21, 2011.
World Health Organization. Strategic Vision. World Health Organization. Available at http://www.who.int/hiv/pub/mtct/strategic_vision.pdf. Accessed: June 21, 2011.
Centers for Disease Control and Prevention. Achievements in public health. Reduction in perinatal transmission of HIV infection--United States, 1985-2005. MMWR Morb Mortal Wkly Rep. 55(21):592-7. [Medline]. [Full Text].
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2004. US Department of Health and Human Services, Centers for Disease Control and Prevention. 2005. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2004report/pdf/2004SurveillanceReport.p.
Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. National vital statistics reports; vol 58 no 19. Hyattsville, MD: National Center for Health Statistics. 2010. Available at http://www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf. Accessed: June 21, 2011.
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. Trop Med Int Health. 2006 Dec. 11(12):1841-8. [Medline].
Preidis GA, McCollum ED, Mwansambo C, Kazembe PN, Schutze GE, Kline MW. Pneumonia and malnutrition are highly predictive of mortality among African children hospitalized with human immunodeficiency virus infection or exposure in the era of antiretroviral therapy. J Pediatr. 2011 Sep. 159(3):484-9. [Medline].
Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: Preliminary Data for 2009. National Vital Statistics Reports. DHHS, National Center for Health Statistics. 2011. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_04.pdf.
Guidelines for the use of antiretroviral agents in pediatric HIV infection. Center for Disease Control and Prevention. MMWR Recomm Rep. 1998 Apr 17. 47:1-43. [Medline].
Lyon ME, Garvie PA, D'Angelo LJ, Dallas RH, Briggs L, Flynn PM, et al. Advance Care Planning and HIV Symptoms in Adolescence. Pediatrics. 2018 Nov. 142 (5):[Medline].
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. 2000 Aug. 19(8):729-34. [Medline].
Brown DM, Jabra-Rizk MA, Falkler WA Jr, Baqui AA, Meiller TF. Identification of Candida dubliniensis in a study of HIV-seropositive pediatric dental patients. Pediatr Dent. 2000 May-Jun. 22(3):234-8. [Medline].
Shapiro RL, Hughes MD, Ogwu A, Kitch D, Lockman S, Moffat C, et al. Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med. 2010 Jun 17. 362(24):2282-94. [Medline].
Lipshultz SE, Shearer WT, Thompson B, et al. Cardiac effects of antiretroviral therapy in HIV-negative infants born to HIV-positive mothers: NHLBI CHAART-1 (National Heart, Lung, and Blood Institute Cardiovascular Status of HAART Therapy in HIV-Exposed Infants and Children cohort study). J Am Coll Cardiol. 2010 Dec 28. 57(1):76-85. [Medline].
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. 2006 Apr-Jun. 20(2):103-7. [Medline].
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. 1996 May. 22(5):794-800. [Medline].
Perry RT, Mmiro F, Ndugwa C, Semba RD. Measles infection in HIV-infected African infants. Ann N Y Acad Sci. 2000 Nov. 918:377-80. [Medline].
Enwonwu CO, Falkler WA Jr, Idigbe EO, Savage KO. Noma (cancrum oris): questions and answers. Oral Dis. 1999 Apr. 5(2):144-9. [Medline].
Jaquet D, Lévine 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. 2000 Sep 29. 14(14):2123-8. [Medline].
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. 2000 Jun. 10(6):499-505. [Medline].
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. 1993 Aug. 29(2 Pt 1):269-72. [Medline].
Kest H, Brogly S, McSherry G, Dashefsky B, Oleske J, Seage GR 3rd. Malignancy in perinatally human immunodeficiency virus-infected children in the United States. Pediatr Infect Dis J. 2005 Mar. 24(3):237-42. [Medline].
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. 2003 May. 13(3):180-5. [Medline].
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. 1996 Jan 17. 65(2):200-3. [Medline].
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. 2000 May-Jun. 22(3):207-14. [Medline].
[Guideline] Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006 Sep 22. 55:1-17; quiz CE1-4. [Medline]. [Full Text].
Committee opinion no: 635: prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol. 2015 Jun. 125 (6):1544-7. [Medline].
Skwarecki B. ACOG updates recommendations for prenatal HIV testing. Medscape Medical News. Available at http://www.medscape.com/viewarticle/845416. May 27, 2015; Accessed: June 25, 2015.
Adolescents and HIV Infection: The Pediatrician's Role in Promoting Routine Testing. Pediatrics. 2011 Nov. 128(5):1023-9. [Medline].
[Guideline] Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. AIDSinfo. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf. Accessed: December 23, 2013.
[Guideline] Mofenson LM, Brady MT, Danner SP, Dominguez KL, Hazra R, Handelsman E, et al. Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. MMWR Recomm Rep. 2009 Sep 4. 58:1-166. [Medline]. [Full Text].
Mirani G, Williams PL, Chernoff M, Abzug MJ, Levin MJ, Seage GR 3rd, et al. Changing Trends in Complications and Mortality Rates Among US Youth and Young Adults With HIV Infection in the Era of Combination Antiretroviral Therapy. Clin Infect Dis. 2015 Dec 15. 61 (12):1850-61. [Medline]. [Full Text].
Violari A, Cotton MF, Gibb DM, Babiker AG, Steyn J, Madhi SA, et al. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008 Nov 20. 359(21):2233-44. [Medline]. [Full Text].
Boerner H. New HIV Remissions Capture the Imagination of Specialists. Medscape Medical News. Available at http://www.medscape.com/viewarticle/883386#vp_1. July 25, 2017; Accessed: July 28, 2017.
Cotton M, Cassim H, Pavía-Ruz N, Garges HP, Perger T, Ford SL, et al. Pharmacokinetics, safety and antiviral activity of fosamprenavir/ritonavir-containing regimens in HIV-infected children aged 4 weeks to 2 years- 48 week study data. Pediatr Infect Dis J. 2013 Jul 9. [Medline].
Frange P, Briand N, Avettand-Fenoel V, et al. Lopinavir/Ritonavir-based Antiretroviral Therapy in Human Immunodeficiency Virus Type 1-infected Naive Children: Rare Protease Inhibitor Resistance Mutations But High Lamivudine/Emtricitabine Resistance at the Time of Virologic Failure. Pediatr Infect Dis J. 2011 Aug. 30(8):684-8. [Medline].
Lowes R. Tivicay Approved to Treat HIV-1 Infection. Medscape Medical News. Aug 12 2013. [Full Text].
FDA. FDA approves new drug to treat HIV infection. Aug 12 2013. [Full Text].
US Food and Drug Administration. New Isentress (raltegravir) dosage form: oral suspension. December 20, 2013. Available at http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/HIVandAIDSActivities/ucm379632.htm. Accessed: January 13, 2014.
Merck & Co, Inc. Merck receives FDA Approval for Isentress (raltegravir) for pediatric oral suspension. January 8, 2014. Available at http://www.mercknewsroom.com/news-release/prescription-medicine-news/merck-receives-fda-approval-isentress-raltegravir-pediatric-. Accessed: January 13, 2014.
Brooks M. FDA clears new formulation of raltegravir for infants. Medscape Medical News. January 9, 2014. [Full Text].
Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir AF) [package insert]. Foster City, CA: Gilead Sciences, Inc. November 2015. Available at [Full Text].
Complera (emtricitabine/rilpivirine/tenofovir DF) [package insert]. Foster City, CA: Gilead Sciences, Inc. February 2016. Available at [Full Text].
Biktarvy (bictegravir/emtricitabine/tenofovir AF) [package insert]. Foster City, CA: Gilead Sciences, Inc. June 2019. Available at [Full Text].
Symtuza (darunavir/cobicistat/emtricitabine/tenofovir alafenamide) [package insert]. Titusville, NJ: Janssen Therapeutics. March 2020. Available at [Full Text].
Chasela CS, Hudgens MG, Jamieson DJ, Kayira D, Hosseinipour MC, Kourtis AP, et al. Maternal or infant antiretroviral drugs to reduce HIV-1 transmission. N Engl J Med. 2010 Jun 17. 362(24):2271-81. [Medline].
Coovadia HM, Brown ER, Fowler MG, et al. Efficacy and safety of an extended nevirapine regimen in infant children of breastfeeding mothers with HIV-1 infection for prevention of postnatal HIV-1 transmission (HPTN 046): a randomised, double-blind, placebo-controlled trial. Lancet. 2012 Jan 21. 379(9812):221-8. [Medline].
van Dijk JH, Sutcliffe CG, Hamangaba F, Bositis C, Watson DC, Moss WJ. Effectiveness of Efavirenz-Based Regimens in Young HIV-Infected Children Treated for Tuberculosis: A Treatment Option for Resource-Limited Settings. PLoS One. 2013. 8(1):e55111. [Medline]. [Full Text].
Treating HIV-infected People with Antiretrovirals Protects Partners from Infection: Findings Result from NIH-funded International Study. News release May 12, 2011. Available at http://www.niaid.nih.gov/news/newsreleases/2011/pages/hptn052.aspx.
Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, et al. Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand. N Engl J Med. 2009 Dec 3. 361(23):2209-20. [Medline].
Descovy (emtricitabine/tenofovir AF) [package insert]. Foster City, CA: Gilead Sciences. October, 2019. Available at [Full Text].
MacNeil JR, Rubin LG, Patton M, Ortega-Sanchez IR, Martin SW. Recommendations for Use of Meningococcal Conjugate Vaccines in HIV-Infected Persons - Advisory Committee on Immunization Practices, 2016. MMWR Morb Mortal Wkly Rep. 2016 Nov 4. 65 (43):1189-1194. [Medline]. [Full Text].
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. 2003 Nov 7. 17(16):2331-6. [Medline].
Brooks M. Efavirenz Gets Expanded Indication for HIV. Medscape Medical News. Available at http://www.medscape.com/viewarticle/803701. Accessed: May 15, 2013.
[Guideline] World Health Organization. HIV and Infant Feeding. Revised Principles and Recommendations. World Health Organization. Available at http://whqlibdoc.who.int/publications/2009/9789241598873_eng.pdf. Accessed: June 29, 2011.

Media Gallery

Genome layout of human immunodeficiency virus (HIV)–1 and HIV-2.

of 1

Table 1. CDC Immunologic Categories for HIV-Infection in Children Based on Absolute CD4 ⁺ Counts

Category
Category	< 1 y	1-5 y	6-12 y
1 - No suppression	≥1500 (>25)	≥1000 (>25)	≥500 (>25)
2 - Moderate suppression	750-1499 (15-24)	500-999 (15-24)	200-499 (15-24)
3 - Severe suppression	< 750 (< 15)	< 500 (< 15)	< 200 (< 15)

Table 2. Antibiotics for Primary and Secondary Prophylaxis of Opportunistic Infections

Infection	Indication	First-Line Regimen	Alternative Regimen
TB	PPD test result >5 mm	Isoniazid and pyridoxine qd for 9 mo	Rifampin for 4 mo
TB	Exposure	Isoniazid and pyridoxine 3 times/wk for 9 mo, rifampin and pyrazinamide qd for 2 mo	Consult an infectious diseases specialist if the pathogen is multidrug resistant
PCP	CD4⁺ finding*	Trimethoprim-sulfamethoxazole qd	Trimethoprim-sulfamethoxazole 3 times/wk
	Fever of unknown origin for 2 wk, history of infection	Dapsone, pyrimethamine, and leucovorin	Dapsone or aerosolized pentamidine in children >5 y
	---	Atovaquone	Atovaquone
Toxoplasmosis	CD4⁺ count < 100 cells/mL	Trimethoprim-sulfamethoxazole qd	Dapsone, pyrimethamine, and leucovorin
	Positive immunoglobulin G finding	None	Atovaquone
	Previous infection	Sulfadiazine, pyrimethamine, and leucovorin	Clindamycin, pyrimethamine, and leucovorin
MAC infection	CD4⁺ finding^**	Azithromycin qwk	Rifabutin qd or clarithromycin bid
MAC infection	Previous infection	Clarithromycin or azithromycin qd and ethambutol	Clarithromycin or azithromycin qd and ethambutol
Abbreviations: bid = twice daily; PPD = purified protein derivative; qd = every day; qwk = every week. ^* See Table 4 **See Table 5

Table 3. Drugs and Doses for Prophylaxis of Opportunistic Infections

Drug	Dose
Azithromycin	20 mg/kg/dose (1.2 g maximum) PO qwk or 5 mg/kg/dose (250 mg maximum) PO qd
Clarithromycin	7.5 mg/kg/dose (500 mg maximum) PO bid
Clindamycin	20-30 mg/kg/d PO qid
Dapsone	1-2 mg/kg/d (100 mg maximum) PO qd
Ethambutol	15 mg/kg/dose (900 mg maximum) PO qd
Isoniazid	10-15 mg/kg/dose (300 mg maximum) PO/IM qd
Leucovorin	5 mg PO 3 times/wk
Pentamidine	4 mg/kg/dose monthly
Pyrimethamine	15 mg/m²/dose (25 mg maximum) PO qd
Rifabutin	5 mg/kg/dose (300 mg maximum) PO qd
Rifampin	10-20 mg/kg (600 mg maximum) PO/IV qd
Sulfadiazine	85-120 mg/kg/d PO bid
Trimethoprim-sulfamethoxazole	150/750 mg/m²/d PO bid
Abbreviations: bid = twice daily; PO = by mouth; qd = every day; qwk = every week.

Table 4. CD4 ⁺ -Based Indications for Starting PCP Prophylaxis

Age or Status	CD4⁺ Count, cells/mL	CD4⁺ Percentage
6 wk to 1 y	Any	Any
1-2 y	< 750	< 15
2-5 y	< 500	< 15
>5 y	< 200	< 15
Previous PCP infection	Any	Any

Table 5. CD4 ⁺ -Based Indications for MAC Prophylaxis

Age or Status	CD4⁺ Count, Cells/mL
< 1y	< 750
1-2 y	< 500
2-6 y	< 75
> 6 y	< 50
Previous infection	Any

Table 6. Risk Factors for Vertical Transmission

Period	Factors That Increase Risk	Factors That Decrease Risk
Prenatal	Acute HIV infection Viral load >10,000 Cigarette smoking Illicit IV drug use	Viral load < 1000 Zidovudine treatment Neutralizing antibodies
Perinatal	Rupture of membranes for >4 h Chorioamnionitis Emergency cesarean delivery Surgical delivery Episiotomy Use of scalp electrodes	Elective cesarean delivery with zidovudine treatment
Neonatal	Prematurity Low birth weight First-born twin	Full-term Second-born twin
Postdelivery	Breastfeeding	ART

Back to List

Author

Delia M Rivera, MD Assistant Professor, Department of Pediatrics, Division of Infectious Disease and Immunology, University of Miami Leonard M Miller School of Medicine

Delia M Rivera, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Richard E Frye, MD, PhD Professor of Child Health, University of Arizona College of Medicine at Phoenix; Chief of Neurodevelopmental Disorders, Director of Autism and Down Syndrome and Fragile X Programs, Division of Neurodevelopmental Disorders, Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital

Richard E Frye, MD, PhD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

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, Pennsylvania Academy of Dermatology, and Pennsylvania Medical Society