Pediatric HIV
(full text of 2009 Guidelines: Evaluation and Management of the Infant Exposed to HIV-1 in the United States)

Problem: CD4+ cells are infected (including T helper lymphocytes and macrophages) which affects both the humoral and cellular arms of the immune system

Definition of AIDS: When opportunistic or persistent infections have occurred or when the CD4 count is less than 200 in a child >12 yrs old.


Signs and Symptoms

AIDS-defining infections

HIV testing

Lab Monitoring

Mother to Child Transmission

  1. Natural hx of HIV: 25% ransmission rate
  2. If use AZT-antepartum,intrapartum, and for the newborn: 5-8%transmission rate
  3. If use highly active antiretroviral therapies including AZT-antepartum, intrapartum, and for the newborn: 1-2%transmission rate


Pneumocystis jiroveci Prophylaxis. Use Bactrim or dapsone.

Guidelines for Anti-Retroviral Treatment

  1. Use combination of drugs (at least 3) to maximize the antiviral effect and minimize cross-resistance
  2. Monitor HIV RNA and CD4 T-cell counts
  3. Reduce HIV RNA as much as possible for as long as possible
  4. Immunizations:
    1. Standard immunizations are recommended for children who have HIV infection
    2. Annual influenza recommended
    3. Varicella vaccine has been shown to be safe and immunogenic in HIV-infected children who have normal CD 4 counts
    4. Live viral vaccines should never be administered to children who have the lowest CD 4 counts.

CHLA Board Review 2005