Acquired Immune Deficiency Syndrome has become one of the major medical problems of the 20th century. This disease provokes a virus that leads to suppression of the human immune system. Do not bypass the infection and children. HIV in a child has its own characteristics of the course and therapy, which we will consider further.
Why does the development of the disease begin?
The source of infection is a person with AIDS or a carrier of the virus. The peculiarity of the microorganism is such that for several years it can be in the body and not provoke the appearance of negative symptoms.
AIDS is the final stage of a disease that leads to serious complications and death. The virus can be found in any biological fluid, penetrating into a he althy child's body, it causes the death of cells responsible for immunity.
At the first stages, the body copes, compensating for the loss by producing new cells. But this does not always continue, the immune system of HIV-infected children is greatly depleted and the body becomessusceptible to any infections that lead to death.
How do children get infected?
For the body of a child or an adult, it is not the virus itself that is dangerous, but the consequences to which it leads. HIV can be transmitted to a child in the following ways:
- During fetal development through the membranes of the fetus, the placenta.
- While breastfeeding with contaminated colostrum.
- HIV can be transmitted from mother to child during labor while passing through the birth canal.
- Through broken skin with a poorly processed instrument.
- In the process of a blood transfusion or organ transplant.
The earlier the infection occurs, the more severe the HIV infection in children.
Detection of the virus in children
Accurate diagnosis is made only after a complete examination, which includes the following tests:
- Polymerase chain reaction. The study allows you to detect HIV RNA in the body.
- Determination of immune status. It should be borne in mind that immunity in children is not yet fully formed, so the result of the analysis differs from that in adults. This child's HIV test will be lower.
- Determination of viral load. And this figure will be higher with HIV than in adults.
- ELISA. The analysis allows you to detect antibodies to the immunodeficiency virus in the blood. If the result is positive, then the analysis is repeated,already using the immune blot method.
Doctors should take into account the fact that the ELISA method does not allow to detect the infection in the first six months after its penetration into the body. During this period, the immune system is still trying to fight, so repeated studies are needed after 3 and 6 months if infection is suspected.
First symptoms of infection
After the introduction of the virus into the body, the incubation period begins. It can take from several months to 10 years before the first symptoms of HIV appear in a child. It all depends on the age of infection.
After the end of the incubation stage, the disease develops rapidly. If children are HIV-positive, then the following symptoms can be observed:
- Body temperature over 38 degrees. Such indicators can last up to several weeks. This is how the body reacts to viruses.
- Lymph nodes increase.
- Increased sweating begins.
- On ultrasound, the liver and spleen are enlarged.
- May develop a rash over the body.
- Changes in analyzes appear.
If children have HIV infection, there are often disorders of the nervous system. Depending on the involvement of different departments are noted:
- Encephalitis. The disease manifests itself as forgetfulness, muscle weakness in the early stages, and then the temperature rises, convulsions appear.
- Meningitis. Begins with headaches, nausea and vomiting, andthen the temperature rises, the child loses weight, gets tired quickly.
- Myelopathy develops when the spinal cord is damaged. There is weakness in the legs, which gradually turns into complete immobility. The functioning of the pelvic organs is disrupted, sensitivity decreases. With the defeat of peripheral nerve endings, polyneuropathy develops. The volume of muscle tissue decreases, immobility.
- Encephalopathy. With this pathology, memory suffers, motor skills are disturbed, fatigue and lethargy appear.
In infants, signs of damage to the nervous system become most clearly visible by 2 months:
- Convulsions appear.
- Muscles are in increased tone not only during movements, but also at rest.
- There is an inconsistent work of the movements of the arms and legs.
- Mental retardation.
Symptoms of HIV in a child at any age are almost the same, but some features can be distinguished.
If a newborn is born with this infection, then, as a rule, this happens prematurely or the baby lags behind his peers in weight. Also, for HIV-infected children, herpes or cytomegalovirus infection is characteristic in utero. Characteristic external signs can be noted: shortened nose, large forehead, strabismus, full lips, developmental defects.
Babies infected during passage through the birth canal often show symptoms around six months of age:
- Poor weight gain.
- Lymph nodes are enlarged.
- The mental andphysical development: late start to sit, walk.
- Increased body temperature.
- Skin rashes and fungal infections.
- Stomatitis.
- The work of the heart, respiratory organs, kidneys is disturbed.
- Child does not eat well, nausea and vomiting appear.
- Infectious diseases are common.
- Blood test shows low levels of white blood cells and platelets.
If a child was born he althy, HIV entered the body later, then among the symptoms, in addition to swollen lymph nodes, fever, the following diseases are often observed:
- Pneumocystis pneumonia with obsessive cough, sweating, high fever.
- Interstitial pneumonia.
- Sluggish course with cough without sputum, shortness of breath with increasing respiratory failure.
- Brain tumors and Kaposi's sarcoma. These pathologies develop much less frequently.
Children of all ages show symptoms of HIV in behavior. The child does not sleep well, loses appetite, apathy, bad mood.
Child of HIV parents
If the immunodeficiency virus is present in the body of the parents, this does not mean at all that the baby will also be born sick. In 98% of cases, he althy children are born from HIV patients, thanks to modern methods of therapy. If a woman is a carrier of the virus or has AIDS, then pregnancy must be planned.
The risk of having a sick baby increases if:
- The mother's blood contains a high concentration of the virus.
- Treatment not given or not effective.
- There was a premature discharge of amniotic fluid.
- Premature baby.
- Baby was injured during childbirth.
To reduce the chance of infection, mothers-to-be with HIV infection are most often given caesarean sections.
Principles of treatment
Modern possibilities of medicine, unfortunately, do not allow to completely rid the patient of a terrible disease. It is only possible to normalize the condition for a while and contain the reproduction of the virus.
If a child was born HIV-infected or acquired the disease after birth, then the following treatment principles are used to provide assistance:
- Providing antiretroviral therapy. If there are concomitant secondary diseases provoked by suppressed immunity, then symptomatic treatment is required.
- Therapy is only prescribed after an appointment with an AIDS specialist and with the consent of parents or guardians.
For successful therapy, it is important to follow the following rules:
- All medicines for the treatment of HIV infection are issued only in a specialized medical institution.
- The doctor gives recommendations on the frequency of administration, dosage, and parents must strictly observe them, otherwise all treatment will be in vain.
- For a more successful treatment, several medications are always prescribed so that the viral particles do not have a chance to adapt to them.
- Therapy most often withthe presence of HIV in a child is carried out on an outpatient basis, only in emergency cases, if indicated, hospitalization is necessary.
Antiretroviral therapy is prescribed for children if there are certain indications, but for babies of the first year of life, this is done without fail. At an older age, indications for such treatment are:
- Child's immune status is less than 15%.
- The number of immune cells is in the range of 15-20%, but there are complications in the form of bacterial diseases.
Administering antiretroviral therapy
The main treatment for confirmed HIV infection is HAART. To increase the effectiveness, a combination of several drugs is used. One drug is most often used for prophylactic purposes or for those children whose HIV status is uncertain.
Medicine has a large number of effective drugs in its arsenal, most often the following are combined with each other:
- Videx.
- Lamivudine.
- Zidovudine.
- "Abacavir".
- Olithid.
- Retrovir.
If the baby is born infected, then from 1-1, 5 months the prevention of pneumonia begins. Assign to the baby:
- "Septrin" or "Bactrim".
- "Trimethoprim" in the amount of 5 mg per kilogram of weight.
- 75 mg Sulfamethoxazole three times a week.
Together with the listed drugs, others are also prescribed:
- Non-nucleoside reverse transcriptase inhibitors: Nevirapine, Atevirdine.
- Protease inhibitors: Saquinavir, Crixivan.
But the appointment of these drugs requires caution and constant monitoring of the child's condition, since therapy is fraught with the development of many adverse reactions: neuropathy, pathology of the gastrointestinal tract.
Treatment of HIV infection is carried out under constant monitoring of the state of the child's immune system. It is important to simultaneously carry out the prevention of secondary infections and the development of neoplasms.
If in a he althy child, opportunistic microorganisms practically do not cause the development of diseases, then HIV-infected or AIDS patients have a weakened immune system that is unable to resist them. When they appear, therapy is accompanied by the selection of the drug, taking into account the nature of the pathogen.
Therapy is also always carried out with the use of not only specialized antiviral drugs, but also prescribed:
- Vitamin preparations.
- Medications that have a general strengthening effect.
- Dietary supplements.
Doctors note that treatment in childhood will be more successful the sooner it is started. But parents should understand that the he alth of their child and life expectancy depends entirely on compliance with all medical recommendations. We must be prepared for the fact that we will have to take medicines for a long time, and maybe all our lives. In addition, observe the daily routine, adhere to a certain diet.
How to prevent the birth of a sick personchild from an infected woman?
HIV prevention for children should begin long before the birth of the baby, if the expectant mother has a disease or is a carrier of the virus. The risk of transmission to a developing baby is about 15% and is much higher during the first trimester due to the immature placenta.
A sick woman can give birth to a he althy baby if she follows a series of recommendations:
- Before 2-2, 5 months of pregnancy, undergo chemotherapy.
- Take the antiretrovirals prescribed by the doctor. Usually, from 14 to 34 weeks, Retrovir is prescribed in an amount of 100 mg 5 times a day.
- Regularly visit a consultation and take tests to track the dynamics of the baby's development and prevent anemia.
Medicine measures during childbirth
Women who are carriers of HIV infection are not forbidden to give birth naturally, but it is not recommended to use various methods of childbirth: obstetric forceps or vacuum aspiration. In practice, doctors do not want to take risks, given that HIV is transmitted to children at the time of passage through the birth canal, they perform a caesarean section.
An hour before the expected time of birth of the baby, the expectant mother is given the drug "Zidovudine". During labor, "Retrovir" is administered intravenously by drip at the rate of 2 mg per kilogram of a woman's weight.
All doctors and nurses delivering and subsequently caring for a baby must wear a gown, mask andgloves.
What to do immediately after childbirth
A newborn baby is not isolated from the mother, but breastfeeding is strictly prohibited. Colostrum can contain viral particles and cause infection. Following childbirth, the following is recommended:
A newborn baby is given "Retrovir" syrup, 2 mg per kilogram of baby's weight every 6 hours. Such therapy continues for 1.5 months of a child's life
- Vaccinate against hepatitis B.
- Do a blood test.
- Conduct an outpatient examination of the infant.
Vaccination of children from infected mothers
Immunization of babies from sick mothers is even more necessary than for he althy babies. It will strengthen the immune system and increase its resistance to dangerous infections. The following drugs are used for vaccination:
- DPT.
- Polio vaccine.
- Hepatitis B.
- Vaccination against measles and mumps.
Doctors should carefully monitor the reactions of the child's body after vaccination.
Advice for parents of HIV positive children
When a sick child is born or when an infection occurs after birth, a great responsibility falls on the shoulders of parents. Much will depend on their behavior in the state of the baby. Following some principles will help prolong the life of a child:
- Mandatory registration at AIDS treatment center and local clinic.
- Go to the doctorrequired for inspection every three months.
- HIV-infected children are seen by a phthisiatrician and a neurologist.
- Regularly tested for immune status and viral load.
- Mantoux reaction is done every 6 months.
- Once every six months, a biochemical analysis of blood, urine, and sugar levels are measured.
- Parents should take into account that the calorie content of the diet of HIV-infected children should be increased by 30%. Nutrition should be rational and balanced with the content of all the necessary vitamins and minerals.
- All vaccinations must be given as scheduled. It can only be changed by the attending physician if there is evidence for this.
Parents should tell their child in an accessible way that HIV has now become an integral part of his life. He must know about this in order to properly fight the infection and follow all the recommendations of doctors.
You should not focus on the negative, you need to make it clear to the baby that you will always be there for him and support him in any situation. HIV is not transmitted through household contacts, so these children can attend regular kindergartens and schools. But this is not easy, unfortunately, in our society, AIDS patients are neglected.
Despite the fact that AIDS and HIV infection cannot be completely cured, timely access to specialists and effective therapy will improve the condition of the little patient.
