The immune system is a wondrously complex and efficient mechanism that continuously defends us from a formidable number of microscopic enemies. Most of its functions are carried out silently as would be invaders are identified and destroyed before they multiply enough to cause any symptoms. Even when defenses are temporarily overcome, in the vast majority of cases the immune system mobilizes enough reinforcements to contain and eventually overcome the infection. Many infections provoke a complex biochemical “memory” called immunity, which helps prevent future invasions by the same organism. One vital component of the immune system is the population of white cells called lymphocytes that play an important role in defending against viruses, fungi, parasites, and certain bacteria. A subgroup called helper T cells is necessary for the normal function of all lymphocytes. It is these cells that are gradually destroyed by the human immunodeficiency virus, or HIV, which results in a gradual deterioration of immune function. Eventually the affected individual develops unusual infections or severe cases of common infections, at which point he is said to have AIDS, or acquired immune deficiency syndrome.
HIV gains access to an uninfected person primarily through events in which blood or certain body fluids pass from one individual to another:
- From an infected mother to her baby, through contact with the mother’s blood either before or at the time of birth. The majority of children with HIV/AIDS have acquired the disease this way. A pregnant woman infected with HIV has a 25 to 35 percent risk of transmitting the virus to her baby (If she has active AIDS, the risk can be as high as 60 to 70 percent.) However, medical treatment can decrease the likelihood of transmitting the virus to her baby to less than 10 percent; therefore, it is now widely recommended that every expectant mother be tested for HIV as part of routine prenatal care.
- From the breast milk of an HIV-infected mother to her baby. Infants born to mothers with HIV should be fed formula.
- Through sexual contact with an infected individual.
- Through shared needles during intravenous drug use, or (much less commonly) improperly cleaned tattoo needles that have been in contact with an infected person.
- Through contaminated blood products during a transfusion. (Careful screening of donors and blood products has virtually eliminated this type of transmission.)
- Through an accidental needle stick of a health-care worker who is drawing or processing blood from an infected person. (This is also an extremely rare cause of HIV (AIDS transmission.)
It is important to note that HIV is not transmitted through everyday interactions – holding hands, hugging, sharing a meal, or other routine activities. It does not pass through the air. Tears, saliva, urine, and stool from an infected individual have not been proven to transmit HIV unless they are contaminated with blood. If blood – or body fluids that might contain it – from an HIV-infected individual must be handled or cleaned up, latex gloves should be worn to prevent direct contact with skin. The virus can be neutralized by a disinfectant such as 10-percent bleach solution (a given amount of bleach diluted by nine times that amount of water).
Initial contact with HIV may produce a mild flulike illness or no symptoms at all. For many months or years thereafter, there may be no unusual symptoms or signs of disease, but during this time the virus gradually destroys the T-cell population. The virus can be transmit-ted to others even while the affected person feels perfectly well. Eventually full-blown AIDS develops, during which a variety of infections become recurrent and disabling problems. These can include unusual pneumonias, chronic diarrhea, abscesses, bone and joint infections, unusually severe episodes of candidiasis or chicken pox, and central-nervous-system infections. The lymph nodes, spleen, and liver commonly become enlarged. An unusual form of cancer known as Kaposi’s sarcoma may develop. HIV also causes damage within the central nervous system. In infants and children, this can result in delays in physical, intellectual, and behavioral development or in the loss of abilities that had previously been present. Inevitably death results from a combination of one or more infections or other complications.
Among infants who are infected with HIV at birth, about 20 percent develop AIDS within the first twelve months and die before the second birthday. In the other 80 percent the disease progresses at a slower rate, and AIDS develops in less than 10 percent of these children each year. HIV that is acquired later in life (most often through sexual contact or intravenous drug use) tends to progress more slowly toward AIDS, and a number of years may pass before any evidence of the disease is apparent. HIV infection is diagnosed through a blood test that detects the presence of specific antibodies against the virus. If they are present, the individual is said to be HIV positive. Additional medical evaluation and ongoing follow-up are very important, even if no symptoms are present, in order to monitor the infected individual’s immune status and general medical condition.
- Slowing the virus’s proliferation and its damage to the immune system. While there is presently no cure for HIV infection, research continues to discover new treatment options that can help contain or slow the disease’s progress. Because these medication regimes are constantly revised based on new research findings, they will not be described here. However, the physician(s) involved in the child’s or adolescent’s care will review the current options, including benefits, risks, and costs. Treatment protocols may require careful attention to proper dosing and timing of multiple medications to obtain the best results.
- Reducing risk of infection. Children with HIV will normally receive routine immunizations, including DTaP (diphtheria/tetanus/pertussis), MMR (measles/mumps/rubella), hemophilus influenza type B and hepatitis B, as well as pneumococcus and influenza vaccines. OPV (oral polio vaccine) should not be given to HIV positive individuals or their immediate family members because of the risk of developing vaccine-related polio. However, IPV (inactivated polio vaccine) may be used instead. While not isolating a child, prudent efforts should be made to minimize his exposure to people who have common infections such as colds, stomach flu, or cold sores (herpes simplex virus infections), or more unusual diseases such as tuberculosis. Ongoing use of antibiotics that prevent certain infections may be recommended for those with significantly reduced levels of helper T cells.
- Treating infections that arise as a result of impaired immunity. This can become a major challenge AIDS progresses and more serious and complicated infections develop. Expert input from specialists, especially in infectious disease, will most likely be necessary.
- General support. Adequate nutrition, regular exercise, and attentive dental care for the infected individual, as well as continued emotional and spiritual support, are all very important in the process of living HIV. In many cases, one or both parents of an HIV-infected child have HIV and/or AIDS, complicating the process of providing care. Meeting the needs of both patient and family will usually require tapping into the resources of an extended family, local church, and community at large. It is very important that HIV-positive children, adolescents, and adults not be cut off from these sources of support, especially out of misguided fear of contracting this infection from casual contact. As deemed appropriate by their physicians, HIV-infected children should be allowed to attend school and activities with other children. Like those with diabetes, asthma, cancer, and other chronic conditions, their life experiences should not be entirely defined by their medical condition.
Who should be told about a child’s infection?
Despite more widespread public knowledge about HIV, there are many reasons it is not easy to tell other people that your child has this infection. Fear of negative reactions and uneasiness about disclosing the manner in which the virus was acquired (especially if one or both parents also infected) can make discussing this disease an intentionally charged issue for many people. For this reason, revealing the diagnosis to just anyone may not be in a child’s (or parent’s) best interest. A child’s doctor and health-care providers who deal with HIV infections on a regular basis can provide valuable input on this aspect. In general, the individuals who should be aware of the diagnosis are those who will be providing some kind of care for the child, including:
- Physicians, dentists, nurses, and other health-care workers who will be involved in medical treatment, whether on a short or long-term basis.
- Caregivers, whether at home or in a day-care environment.
- Relatives who are involved with the child on a regular basis.
Relatives and friends who are not directly involved in the child’s care may be made aware of the diagnosis if they are known to be trustworthy and supportive. Last but not least, the child himself should be informed of his condition in a manner compatible with his age and maturity. For younger children basic facts can be given on a need-to-know basis. An older child or adult will need more detailed information about his illness, its treatment, and his future prospects. In either way, this subject should be approached the same as any other difficult topic: with respect for the child, tempered by compassion and love, while avoiding secrets and misinformation.