| Abstract: | The number or pediatric AIDS cases in the US was around 2000 in 1990, and children under 13 accounted for about 2% of reported cases. Pediatric cases are increasing as the number of infected women increases. Such cases are concentrated in poor urban populations, aggravating the lack of resources of already overtaxed health services. Ethnic minorities are overrepresented among AIDS cases. In the US, 52% of AIDS cases in adult women are in blacks, 27% in non-Hispanic whites, and 20% in women of Hispanic origin. Among children under 13, 53% are in blacks, 25% in Hispanics, and 22% in whites. The majority of children with AIDS were 5 and were probably infected by vertical transmission. Over 80% were born to mothers with AIDS or at risk of HIV infection, 11% received transfusions of contaminated blood, and 5% received contaminated blood products. Through December 1989, 53% of white, 91% of black, and 85% of Hispanic children with AIDS were infected vertically by their mothers. In the US, over 1/2 of cases of vertical AIDS transmission are due to maternal IV drug abuse and 1/5 to mothers who have sexual relations with IV drug abusers. The rate of infection in children born to seropositive mothers has not been established. Estimates of rates of transmission range from 20% to 50%. The factors causing HIV transmission in 1/3 of infants and protecting the other 2/3 have not been identified. Transmission to the infant may occur during pregnancy or delivery or through breast feeding. There is no evidence that cesarean delivery can protect against infection. The risk of intrauterine infection is probably much greater than that of infection during delivery. Diagnosis of HIV infection in young infants is difficult. There are no physical characteristics distinguishing infected newborns, and laboratory diagnosis is unhelpful because maternal HIV antibodies cross the placental barrier to the fetus. There is as yet no vaccine or curative treatment for HIV infection. Prevention of pediatric HIV infection requires prevention of the infection and the disease in pregnant women. Primary prevention in women depends on their being adequately informed about risks and able to change risk behaviors. Secondary prevention is achieved through use of AZT, which slows the progression of the disease, and prevention or treatment of complications. There is no conclusive evidence as yet that pregnancy hastens the progression of maternal HIV infection. Seropositive mothers should avoid breast feeding if adequate substitute foods are available. The average age at appearance of symptoms in infected children is 8 months. Mortality is higher among children manifesting the disease in the 1st year, with a median survival of 38 months. Full information about HIV infection and voluntary and confidential screening should be available to all women contemplating pregnancy. |
