Children with AIDS : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 2)

Determining Who's Infected

But treating children with AIDS may prove more difficult than treating other diseases in children because they have a high rate of false-positive and false-negative responses to HIV tests. As many as half of those under the age of 15 months who test positive for antibody to the virus may not actually be infected and could be harmed by potentially toxic AIDS drugs.

Many false-positive responses occur because the standard AIDS test detects only antibodies to the virus, not the virus itself, and antibodies from the mother routinely cross the placenta to enter the fetus's bloodstream. It can take up to 15 months for maternal antibodies to disappear.

Many false-negative results occur because some children whose immune systems are highly affected by the virus may not be able to make antibodies to it and may have a negative AIDS test despite the infection being present.

According to Pizzo, "It remains a problem to identify those newborns or infants who are really ill from HIV infection at this time. If we could pick out the children that are truly infected it would allow us to provide better therapy for them."

Research into improving the methods for early diagnosis is under way. But until there are tests for the AIDS virus, rather than AIDS antibodies, the best physicians can do to identify children who have HIV infection is to follow their clinical progress.

Weight loss, enlarged lymph nodes, failure to thrive, recurrent infections, and developmental regression are among the many ways HIV disease can manifest itself in children. Nervous system deterioration is much more common in children than adults. Children with HIV infection who appear to have been developing normally may begin to regress, losing their verbal and motor skills.

Prevention the Goal

With no cure for AIDS, preventing the disease has been a major objective.

Trials of AZT in infected pregnant women have just begun. It is hoped they will determine whether AZT might block transmission of the infection to the unborn child.

Because only a third of infants born to infected mothers appear to actually become infected, it is important to find out what maternal, viral or infant factors are involved in the risk for infection. Scientists are trying to determine if certain strains of the virus are more likely than others to be transmitted to the fetus, if the timing of infection has an impact on the clinical manifestations that evolve, and whether that affects the child's prognosis. Pizzo notes that, "These and many other such questions have a major impact on approaching the development of strategies that might block or prevent the infection of the fetus or infant."

Loneliest Victims

Negative social attitudes about AIDS persist, and children are often the loneliest victims of the disease.

A Suffolk County, N.Y., attorney for the mother of an elementary school child with AIDS, says that, "For nearly a year they wouldn't admit [her son] to school. They told us it was because they wanted to train everyone in universal precautions for AIDS. Finally, after a year, they did admit him. But the mother only kept him there for a month and then moved to another state. They told her they would notify everyone in the school. I don't know why she moved, but I guess it was very uncomfortable for her."

In another case Peggy (not her real name) also has a child with AIDS in a public elementary school in Suffolk County. But almost no one knows about it. "I want him to be treated like a normal child. I don't want people to stop hugging and kissing him."

Peggy's children handle the situation a little differently.

"They tell their friends that their brother has cancer," she says. "They think their friends will be more compassionate to him, then. Frankly, they're terrified that if their friends ever do find out the truth, they will stop coming over to the house to play."

There is no evidence that playing with or living with a patient with AIDS puts a person at risk of contracting the disease if infection control guidelines are followed.

There have been no reported cases of children spreading HIV infection to others — even in households where the child has consistently kissed and hugged family members, shared eating utensils, or slept in the same bed with brothers and sisters.

The only documented risks of HIV infection are from direct contact with an infected person's blood or certain other fluids, including semen and vaginal secretions. Since HIV transmission has not been documented from exposure to other body fluids and waste — such as feces, nasal secretions, sputum, sweat, tears, urine, and vomitus — infection control guidelines do not apply to these fluids.

Because diarrhea or diaper rash is likely to be contaminated with blood, gloves should be used when changing or cleaning an infected child with either or both these conditions. Gloves should also be used when bandaging an infected child who has an open wound.

While wearing gloves, one should avoid handling personal items, such as combs and pens, that could become soiled or contaminated. Gloves that have become contaminated with blood or other infectious body fluids should be removed as soon as possible, taking care to avoid skin contact. Contaminated gloves should be placed and disposed of in bags that prevent leakage. Disposable gloves are best, but reusable gloves may also be used if they are cleaned and disinfected properly.

Peggy says that at an earlier time in history, "no family ever touched by [cancer] ever mentioned it because so many people were scared they'd catch it. As we realized that you couldn't catch cancer from somebody, people came out of the closet. I hope the same happens with AIDS."

Since HIV infection is not transmitted by casual contact, Peggy says she hopes "more people will open up their hearts to people that have it — at least for the children."

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.