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1、PediatricHIVInfection ·Author:DeliaMRivera,MD;ChiefEditor:RussellWSteBackgroundOverthepast30years,sincethefirstcasesofwhatisnowrecognizedashumanimmunodeficiencyvirus(HIV)infectionwereidentifiedin1981,thenumberofchildreninfectedwithHIVhasincreaseddramaticallyindevelopingcountr
2、iesbecausethenumberofHIV-infectedwomenofchildbearingagehasrisen.However,greatadvanceshavebeenmadeintheUnitedStatesandinotherindustrializednationstocontroltransmissionofthevirusfrommothertoinfant.IntheUnitedStates,universalprenatalHIVtestinghasbeenrecommendedtoobstetricianssin
3、ce1995.However,thistestingwasnotmandatoryinallstates.Beforeprenataltestingwascommon,diagnosingHIVinfectionsinawomanafterdiagnosingitinherchildwasnotunusual,andthediagnosisofacquiredimmunodeficiencysyndrome(AIDS)inapreviouslyhealthychildwasnotrare.Before1985,onewayinwhichchild
4、renwereinfectedwasthetransfusionofblood-products.Improvedscreeningtestshaveessentiallyeliminatedsuchtransmission.Acommonwayadolescentsbecomeinfectedisbyengaginginhigh-riskbehaviorssuchasunprotectedintercourse,malehomosexualintercourse,andintravenous(IV)drugabuse.Surveillanced
5、atanowshowthattheonlygroupwithincreasingHIVincidenceismenwhohavesexwithmen.Theproportionofthispopulationwhoareunawareoftheirinfectionishigh,withunawarenessamongyoungmen(18-29y)reaching63%.[1]Inpediatricpatients,HIVinfectionprogressesasitdoesinadults,althoughsurveillancedatafr
6、omtheCentersforDiseaseControlandPrevention(CDC)suggestthatpatientswhoareaged13-24yearswhendiagnosedwithAIDSsurvivelongerthanolderindividualsdo.VerticallytransmittedHIVcancauserapidlyprogressive,chronicallyprogressive,oradultlikediseaseinwhichasignificantclinicallatencyperiodo
7、ccursbeforesymptomsappear.The WorldHealthOrganization (WHO)[2] estimatesthatapproximately2.5millionchildrenwerelivingwithHIVinfectionasof2009.In2009alone,370,000childrenwerenewlyinfected.[3] Thisisadropof24%from5yearsearlier.[4]Notonlyarethechildrenthemselvesravagedbydisease,
8、buttheirprimarycaregivershavealsooftensuccumbedtoacquiredimmunedefic
