HIV & AIDS in Children – Causes, Symptoms & Treatment

Being infected with a disease that has no successful treatment can be difficult to deal with, especially in case of little children. Despite enormous efforts to prevent the transfer of the HIV from mother to child, more than 1.5 lakh children were affected by it in 2016 alone.

What is Human Immunodeficiency Virus (HIV) & Auto Immune Deficiency Syndrome (AIDS)?

The infection caused by the Human Immunodeficiency Virus turned into a pan-global epidemic during the 1980’s. Originally thought to have crossed over from monkeys to humans, the disease spread from the United States to the rest of the world.

There is a lot of confusion between HIV and AIDS, both of which have been used interchangeably. They are both connected but are not the same. The HIV, upon entering the body, attacks the CD4 cells, which is a type of immune cell. These immunity cells are then used by the HIV to replicate itself. As a result, the HIV cells begin to increase while the immunity cells begin to decrease. This process can take years to complete during which time the child will show no outward symptoms of infection. Finally, after enough CD4 cells are destroyed, the body is no longer able to defend itself. This makes the body vulnerable to even harmless diseases. Even a common cold will now be deadly as there aren’t enough immunity cells to fight of the cold. Once this level has been reached, it is known as AIDS.

Causes of HIV

There are several ways in which HIV can be transferred to children. Some of these include the following:

• Mother to Child:

Most of the HIV cases in children are due to the fact that their mothers were HIV positive when pregnant. This may happen across the placenta, through breastmilk, or while giving birth.

• Blood Transfusion:

If a child has been in an accident/ requires surgery, there is a chance that the blood obtained by the hospital may be from an individual who carries the HIV. While most hospitals are vigilant, there have been numerous instances where it has been discovered that blood drives campaigns end up taking the blood of infected people.

• Drugs:

Children who have access to injectable drugs are at a high risk of getting HIV. This is because they often share needles which allow the virus to directly enter the bloodstream.

Symptoms of HIV

The symptoms vary depending on the age group and so have been broadly classified into infants and children.

1. In Infants :

Each infant may exhibit different symptoms or all the below:

1. Swollen Lymph Nodes
2. Abnormally sized belly due to the swelling of internal organs
3. White patches on the cheek and tongue indicative of a fungal infection
4. Random bouts of diarrhoea
5. Respiratory diseases like pneumonia

2. In Children :

The aids symptoms in children are similar to an infant but with some other symptoms as well such as:

1. Development of diseases in internal organs such as the liver and kidney
2. Intermittent infections in the ear and nose
3. Lung diseases such as Pneumonitis
4. Persistent fever that lasts for more than four weeks

How is the Diagnosis Done?

The diagnosis is multi-faceted. As HIV can be passed on from mother to child, HIV testing is recommended for all pregnant women. While in some countries this is mandatory, in others there is an opt-out approach, meaning that it optional. Women who test positive for HIV are then kept under observation and the newborn is subjected to testing.

• Newborns:

The standard tests that are done on adults do not work on infants. This is because of passive HIV-antibodies that may have been passed on by the mother’s bloodstream. They are subjected to a test called HIV DNA PCR which can detect the infection a day after it was acquired. This test is suitable for kids who are less than 18 months of age.

• Older Children:

Children who are older can be given the same test that is done for adults. This is called the ELISA test which checks for the HIV antibody. A follow-up Western Blot test is done to confirm the same and avoid a false positive. The rapid HIV tests that are carried out for mass HIV detection programs are also reliable, but this also needs to be followed up with the Western Blot test.

HIV Treatment

HIV treatment focuses on retarding the spread of the virus.

Antiretroviral Therapy :

Antiretroviral Therapy, or ART, is the foundation of HIV treatment. They are drugs that are used to prevent the spreading of the HIV and keeping a healthy amount of CD4 in the body. While it cannot eliminate the virus, it helps to significantly slow down the progression of the disease. ART is often a combination of more than two drugs to ensure that there is no chance of drug resistance. This is known as Combination ART.

Growing Up With HIV

Growing up with this form of infection is not an easy task and has many implications:

• Infants: It is said that children below the four years of age are the most vulnerable to death due to AIDS-related complications.
• Risk of Opportunistic Diseases: As the risk of infection from other diseases is high, they have to live in a protected environment. Tuberculosis, for example, is highly contagious in India and TB speeds up the growth of HIV.
• Schooling: A study conducted shows that most HIV-positive children survive long enough to go to school. While a small percentage was too sick to go to school, most of them had no difficulty in attending regular classes.
• Emotional Stress: There are many instances where parents wish not to tell their children about their condition. However, after a certain age, it becomes obvious to them that they have a medical problem. While the younger children become anxious or depressed, many adolescent children react with anger or resignation.

Disclosure Issues

Who you want to tell about your child’s condition is based on your prerogative. Due to the social stigma attached, there may be some hesitation on who you wish to tell, which is understandable. Limiting it to close family members, doctors, and dentists are sufficient. A study showed that of the 53% HIV-positive children who attend school, the school officials were kept in the dark of their condition.

Exposing others to your child does not put others at risk. Eating, hugging, talking and sitting next to your child will not pass on the disease to other people. However, there are some guidelines that can be followed to keep your child and others safe:

• They can be told to avoid using the same toothbrush.
• When they hit puberty, make sure that their blades are only used by them.
• Educate them on how to treat a wound if they are injured and to dispose of the bandage properly.
• Educating them about the risks and safety measures while performing intercourse (for older children).

Management

HIV is an infection that once acquired, cannot be removed from the body. However, due to the advances in modern medicine, this isn’t a death sentence. Many children affected by HIV can have a normal childhood and live a long life.

• Sensitise Your Child: Your child may not be aware of the concept of HIV or may have some preconceived notions. It is important to have a discussion about what the disease is and how they can live a healthy life.
• Local Doctor: For administering the ART drugs, the presence of a doctor who lives close-by and is experienced with HIV kids is preferable. This is because the proximity allows for easy physical access to the doctor.
• Medicine Intake: The physical intake of the medicine might be difficult for some kids as they may not like the taste. Older kids may not be too thrilled about the side effects and can even go to the extent of hiding the medicines. It can also get embarrassing for them if they must take the medication in front of others. In these instances, it becomes important to have a dialogue with your child and be supportive.
• Routine: While travelling or going for vacations, they may forget to take their medicine. It is important to have a routine in place that your child adheres to.

Prevention

As most cases happen due to infected mother transferring the virus during birth, the prevention methods will be focused exclusively on this.

• Avoid breastfeeding as the virus can be contracted through it.
• HIV positive pregnant women should be started on ART immediately as it reduces the chance of transmission to less than 2 percent.
• Some deliveries are done using a caesarean section to prevent the transmission of the virus.

While it is unfortunate that kids must go through something so traumatising, it is heartening to remember that the incidence of HIV in children has reduced significantly. This can be seen by the fact that in just five years (2010-2015), more than 10 lakh cases of HIV have been averted.