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HIV in Children and Teens

HIV (Human Immunodeficiency Virus) HIV (Human Immunodeficiency Virus)

By Katherine Hsu, MD, MPH, FAAP & Natella Rakhmanina, MD, PhD, FAAP

Human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), can affect anyone. This includes infants, children and teens.

Since HIV first became an epidemic in the 1980s, there have been major advances in treatment and survival rates. But untreated HIV infection often develops into AIDS, which eventually leads to severe illnesses and death.

Teens and HIV

An estimated 21% of all new HIV infections in the United States occur in teens and young adults. Yet most sexually active 13- to 24-year-olds often don't realize that they're at risk for HIV, so they don't get tested. In fact, this age group is more likely than any other to have undiagnosed HIV.

Even when they are diagnosed, teens and young adults are less likely to get treatment. And because this age group also has lower rates of viral suppression (when treatment gets the virus to an undetectable level), they're less likely to stay healthy. All of these factors increase their risk of transmitting HIV to others.

How is HIV spread?

Most often, HIV is transmitted during sexual intercourse through body fluids such as semen and vaginal fluids. It can also be spread through intravenous drug use. Blood, blood products, needles, or other sharp instruments contaminated with infected body fluids or blood can also spread HIV. Infants and children most often get HIV infection from a mother with infection.

The virus cannot be spread through any of the following interactions with an HIV-positive person:

  • Hugging or sitting next to them

  • Shaking their hand

  • Playing with their toys

  • Eating food prepared by them

HIV transmission in schools or childcare centers has not happened either.

Signs & symptoms of HIV

HIV is an infection that lasts a lifetime. But symptoms may not appear for many months or years after picking up the virus. In fact, the average time from getting the virus until developing the signs of AIDS in teenagers and adults is 10 to 11 years. This means that teens and young adults may not be aware that they are infected and can spread HIV to others.

When people are infected with HIV, the virus attacks their immune system. Signs and symptoms may include:

  • Swollen lymph nodes

  • Recurrent diarrhea

  • Minor skin infections

  • Persistent fungal infections of the mouth (thrush)

  • Failure to gain weight or grow in height at a normal rate

  • An enlarged liver and spleen

As the immune system continues to weaken, AIDS-related infections and cancers can develop.

How is HIV diagnosed?

Typically, blood or oral fluids are used to diagnose HIV infection. There are three types of tests available:

  • Nucleic acid test (NAT): This test uses blood to check how much of the virus is in the body.

  • Antigen/antibody test: Antigens are foreign substances (such as a virus, bacteria, or pollen) that cause your immune system to react. When you're exposed to a virus like HIV, your immune system makes antibodies to fight it. In HIV, the specific antigen is called p24. It shows up even before antibodies do. This blood test looks for both HIV antibodies and p24.

  • Antibody test: This test uses either oral fluid or blood to look for HIV antibodies. Self-tests and most rapid tests for HIV are antibody tests.

HIV screening for all teens

All teens ages 15 years and older are recommended to get at least one routine HIV screening. After the first screening, teens who are sexually active should be screened for HIV at least yearly. If they're at high risk, they may even need to be tested every 3 to 6 months and can get risk counselling from your pediatrician.

Teens at high risk for HIV can be prescribed preventive pill once daily with two medicines that are used to treat HIV. Those at high risk include males having male sexual contact; active injection drug users, transgender youth; youth of both genders having sexual partners who are HIV-infected or are injection drug users; youth exchanging sex for drugs or money; or those teens who have had a diagnosis of or request testing for other STIs.

What if the test is positive?

f your teen tests positive for HIV, they need to be promptly linked to care and should consider letting their sexual partners know. For help with this, get in touch with your local or state public health department. They should have a confidential Partner Notification Services program of some sort that can notify your teen's past and present partners without disclosing your teen's identity.

Keep in mind that in some states, the law requires informing sexual or injection partners that you have HIV. You can check your state's HIV-related laws with The Center for HIV Law and Policy.

How is HIV treated?

Doctors use combination of several antiretroviral drugs to treat people with HIV, including infants, children and teens. These medicines lower the levels of HIV in the blood to being undetectable and prevent transmission of the virus through sexual contact. They also help prevent transmission of the virus to others.

Sticking with treatment

It's important for your child to take their HIV medications daily, exactly as they are prescribed. This prevents the development of resistance by HIV and associated infections and helps your child's immune system stay strong and healthy. If your child is having a hard time sticking with their treatment, be sure to talk with your doctor. They can help you pinpoint the problems and come up with a new plan to help make it easier.

Your teen may have been exposed to HIV after risky sexual activity, sharing needles, or sexual violence. In these cases, your doctor will consider giving your child post-exposure prophylaxis (PEP) with medicines that work against HIV. If PEP is taken within 72 hours after exposure, it's extremely effective in preventing HIV.

For teens at high risk for HIV, your doctor can also prescribe a pill with two medicines to be taken daily that can prevent acquiring HIV. Other more long-acting medicines that can prevent acquiring HIV may soon become available.

What is the outlook for children and teens with HIV?

HIV infection is a serious, life-threatening disease with no effective cure, but very effective treatment. When it’s undiagnosed or HIV medications aren’t taken regularly, people are more vulnerable to serious illnesses. But the good news is that HIV-infected kids and teens can expect to live a long and fulfilled life as long as they take their medications as directed.

How to prevent HIV transmission

Teens

In 2019, 27% of high school students reported that they engaged in sexual activity. By the 12th grade, this number was up to 37%. But only 54% of sexually active high school students said they used condoms during their last sexual encounter.

If your teenager is sexually active, they need to practice safe sex. This means using a condom during EVERY sexual experience. Even when people infected with HIV don't have symptoms, they can still spread the virus to others.

Pre-exposure prophylaxis (PrEP) is an option if your teen is at risk for getting HIV. PrEP means taking medicine to prevent acquiring HIV. When it's taken as prescribed, PrEP lowers your risk of getting HIV by around 99%.

Pregnant women & babies

Medicines that work against HIV help a pregnant woman with HIV to prevent transmitting the virus to her baby. These medicines keep the mom-to-be healthy too.

If you have HIV, your newborn will be treated with medicines that work against HIV for at least few weeks, until becomes clear whether or not the baby is infected.

Breast milk can transmit HIV to your baby. Infant formula feeding is usually preferred instead. When your baby starts eating solid foods, don't pre-chew the baby's food to avoid passing the virus to your baby.

Remember

Talk with your pediatrician if you have any questions about HIV and how to stay healthy

More information

About Dr. Hsu

Katherine Hsu, MD, MPH, FAAP, is the Medical Director for the Division of STD Prevention & HIV/AIDS Surveillance, Massachusetts Department of Public Health, and the Director of the Ratelle STD/HIV Prevention Training Center, one of eight STD clinical training centers funded by the Centers for Disease Control and Prevention. She is also a Professor of Pediatrics at Boston University Medical School and Attending Physician in Pediatric Infectious Diseases at Boston University Medical Center. Dr. Hsu is board certified in the areas of Pediatrics and Pediatrics Infectious Diseases, and is a Fellow of American Academy of Pediatrics.

About Dr. Rakhmanina

Natella Rakhmanina, MD, PhD, FAAP is a Professor of Pediatrics at the George Washington University and serves as a Director of the HIV Program at Children's National Hospital in Washington, DC, USA. For more than 20 years she has been providing clinical care to HIV-infected infants, children and adolescents, and continues her practice treating pediatric and adolescent patients. She is certified in HIV medicine and serves as a principal investigator of NIH, CDC and industry funded pediatric and adolescent HIV studies. Dr. Rakhmanina is also a Senior Technical Advisor at Elizabeth Glaser Pediatrics AIDS Foundation, leading several projects on pediatric and adolescent HIV treatment in Sub-Saharan African countries. Dr. Rakhmanina is a Chair of the Committee on Pediatric AIDS at the American Academy of Pediatrics, and serves on the U.S. Department of Health and Human Services Panel on the Pediatric Antiretroviral Therapy and Management Guidelines at the Office of AIDS Research Advisory Council in National Institutes of Health.

Last Updated
11/4/2022
Source
American Academy of Pediatrics Committee on Pediatric AIDS (Copyright © 2022)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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