HIV and AIDS in Children

Original Editor - Franca Ebomah

Top Contributors - Franca Ebomah and Kim Jackson  

Introduction[edit | edit source]

There is an unacceptably high number of children becoming recently infected with HIV globally[1]. Poor mental health outcomes is a risk factor for children with Human Immunodeficiency Virus (HIV)[2]HIV/AIDS in children is a significant problem in developing countries[3]According to UNICEF data, 4 in 10 infants born to pregnant women living with HIV miss out on a timely diagnosis.[4]

Etiology[edit | edit source]

  1. Children can contract the virus from their mothers during the child bearing process or from breastfeeding. This is the most common cause.
  2. Orphans and children who lack caregivers in AIDS communities are vulnerable to contracting HIV. They are unable to stand up for their rights and are predisposed to infection through rape and sexual abuse.
  3. In countries where child marriages are culturally accepted, young girls are at risk of contracting the virus from their older husbands and passing it on to their children.
  4. Injected drugs
  5. Blood Transfusion
  6. Sharing of needles[5]

Epidemiology of HIV/AIDS in Children[edit | edit source]

  • Worldwide, there are approximately 2.78 million children aged 0-19 years living with HIV[6]
  • In 2020, approximately 850 children became infected with HIV daily and 330 children died from AIDS-related causes daily.
  • Close to 90% of children newly infected with HIV in 2020 were from sub-Saharan Africa.
  • Female children consist a higher percentage of children with HIV [7]
  • Children under 1 year of age are among those most vulnerable to HIV. [4]
  • Approximately 15.4 million children globally have lost one or both parents to an AIDS-related cause.

Symptoms and Complications of HIV in Children[edit | edit source]

  • Failure to thrive (such as not gaining weight)
  • Delayed developmental milestones
  • Seizures
  • Childhood illnesses such as an ear infection, a cold, an upset stomach, or diarrhea
  • Opportunistic infections such as Pneumocystis pneumonia (a fungal infection of the lungs), Cytomegalovirus (CMV), lymphocytic interstitial pneumonitis (lung scarring)[5]
  • Tuberculosis (major infectious complication of HIV in developing countries)[8]
  • Anemia
  • Neurological abnormalities such as microcephaly and cognitive, language and motor deficits


There are three conditions commonly found in HIV infected children. These include:

  1. Pneumocystis carinii pneumonia (PCP)
  2. Lymphoid interstitial pneumonitis (LIP)
  3. Developmental delay and HIV encephalopathy[8]

Pneumocystis carinii pneumonia:

  • Infants present with severe tachypnoea, dyspnoea, fever and a non-productive cough.
  • It is a progressive disease
  • Common cause of severe and fatal pneumonia in children

Lymphoid interstitial pneumonitis:

  • Slowly progressive interstitial lung disease with unknown aetiology
  • Presentation include: tachypnoea, a productive cough, wheezing, hypoxaemia and right-sided heart failure.

Developmental delay and HIV encephalopathy:

  • Developmental delay may be the first sign of HIV infection occurring in the absence of other clinical signs or symptoms.
  • Progression may be halted and even reversed with the administration of antiretroviral drugs.
  • May progress to include pyramidal tract signs, ataxia, abnormal muscle tone and psuedobulbar palsy.
  • Encephalopathy may result in spastic quadriparesis with dystonic posturing and regression in motor milestones.[9]

Effects of HIV[edit | edit source]

There are direct and indirect effects of HIV.

Direct effects: HIV has direct neurotoxic effects on brain structures involved in the regulation of emotion, behavior, and cognition.[10]

Indirect effects: These include social stressors, poverty, illness and trauma on morbidity and mortality[11]

Children infected with HIV/AIDS are at increased risk of developmental and neuropsychological disturbances owing to both the direct and indirect effects of the HIV.[10]

Diagnosis of HIV in children[edit | edit source]

It is important to note that diagnosing of children with HIV under the age of 15-18 months can be complicated by the presence of maternal antibodies in the child’s blood stream. These antibodies may lead to false positive results.[9]

There are two methods used to diagnose HIV in children:

  1. Serological testing: This is the most cost-effective and widely used method. Two types of this method exist- ELISA and Western Blot. However, these tests are unable to distinguish whether the antibodies are maternal or due to the child’s own response to HIV infection.
  2. Polymerase Chain Reaction test: More accurate method of testing. It detects the presence of HIV DNA in the child’s leucocytes. It is the test of choice in children under the age of 18 months but is very expensive and requires specialized laboratory facilities

Management[edit | edit source]

When a child has HIV, the family is affected not just the individual. Therefore, health professionals should adopt a family centered approach to management.[9] Generally, the best way to manage pediatric HIV/AIDS is to prevent mother to child transmission. [3]Although considerable progress in the management of HIV has been made since 2010, there is a long way to go for paediatric treatment of HIV.[4]

Early diagnosis and treatment are particularly critical in the case of infants[4]In South Africa, children become eligible to t receive antiretroviral (ART) on government programmes only when their CD4 counts are less than 15% of normal (significant immune system compromise).

Role of Physiotherapy[edit | edit source]

Pneumocystis carinii pneumonia (PCP):

  • Education of caregivers on the progression and home management of the disease
  • Acute dyspnoea management
  • Prevention of secondary infections by maintaining optimal bronchial hygiene
  • Optimising functional abilities[9]

Lymphoid interstitial pneumonitis (LIP):

  • Chest Physiotherapy and active cycle of breathing to improve ventilation and bronchial hygiene
  • Prevent secondary chest infections
  • Monitored exercise program[9]

Developmental delay and HIV encephalopathy:

  • A family centred approach that addresses the child’s functional difficulties within the context of their family and home environment may be appropriate.[9]

References[edit | edit source]

  1. UNAIDS. Ending of the AIDS epidemic. 2021. Available from https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf. 14/12/2021
  2. Sharp C, Penner F, Marais L, Skinner D. School connectedness as psychological resilience factor in children affected by HIV/AIDS. AIDS care. 2018 Jul 25;30(sup4):34-41.
  3. 3.0 3.1 Embree J. The impact of HIV/AIDS on children in developing countries. Paediatrics & child health. 2005 May 1;10(5):261-3.
  4. 4.0 4.1 4.2 4.3 UNICEF Data(2021). Paediatric care and treatment. Available from: https://data.unicef.org/topic/hivaids/paediatric-treatment-and-care/. (Accessed on 01/01/2021).
  5. 5.0 5.1 Dunkin M.A. (2020). Children With HIV and AIDS. Available from: https://www.webmd.com/hiv-aids/guide/hiv-in-children. Accessed on 01/01/2022
  6. UNICEF Data. HIV Statistics- Global and Regional Trends. Available from:https://data.unicef.org/topic/hivaids/global-regional-trends/#:~:text=Global%20trends,live%20in%20sub%2DSaharan%20Africa. (Accessed 01/01/2022)
  7. HIV.gov. Global Statistics. Available from: https://data.unicef.org/topic/hivaids/global-regional-trends/#:~:text=Global%20trends,live%20in%20sub%2DSaharan%20Africa. (Accessed 01/01/2022).
  8. 8.0 8.1 Asnake S, Amsalu S. Clinical manifestations of HIV/AIDS in children in Northwest Ethiopia. Ethiopian Journal of Health Development. 2005 Jun 24;19(1):24-8.
  9. 9.0 9.1 9.2 9.3 9.4 9.5 Potterton, J. and van Aswegen H. Paediatric HIV in South Africa: an overview for physiotherapists. South African Journal of Physiotherapy. 2006 Mar 1;62(1):19.
  10. 10.0 10.1 Benton TD, Lachman A, Seedat S. HIV and/or AIDS. Addressing the mental health needs of affected children and families. IACAPAP e-textbook of child and adolescent mental health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. 2013. Available from: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2023-9. (Accessed on 01/01/2022)
  11. Boivin MJ, Ruiseñor-Escudero H, Familiar-Lopez I. CNS impact of perinatal HIV infection and early treatment: the need for behavioral rehabilitative interventions along with medical treatment and care. Current Hiv/Aids Reports. 2016 Dec;13(6):318-27.