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  • Use of highly active antiretroviral therapy (HAART) in children and adolescents has improved survival, decreased hospitalization rates, and transformed HIV infection from a uniformly fatal to a chronic disease.
  • The epidemic of HIV in pediatrics has changed from a predominance of infection in infants with perinatal HIV infection to adolescents between 13 and 24 years of age infected through sexual transmission, either heterosexual or men who have sex with men.
  • The Centers for Disease Control and Prevention has recommended routine HIV testing for all patients 13 to 64 years of age in health care settings, including the emergency department (ED).
  • Rapid HIV tests with high sensitivity and specificity, using blood or oral fluid specimens, are available for diagnostic testing for HIV in the ED.
  • Acute HIV infection presents most often as an infectious mononucleosis-like illness and is best diagnosed through use of nucleic acid amplification tests, such as the HIV-1 RNA PCR which measures the viral load in a patient's blood.
  • Use of standard precautions, knowledge of the pediatric HIV patient's CD4 count and percentage, as well as communication with the patient's HIV provider are important principles to guide management in the ED.
  • Acute HIV infection should be considered in the adolescent who presents to the ED with fever, pharyngitis, oral ulcers, lymphadenopathy, gastrointestinal symptoms, and a maculopapular or papulovesicular rash.
  • Infections most likely to be seen in the pediatric or adolescent HIV patient with a CD4 percentage < 25 include herpes zoster and oral candidiasis.
  • An important life-threatening complication of antiretroviral therapy to recognize in the pediatric or adolescent patient seen in the ED is lactic acidosis.
  • The issue of postexposure prophylaxis for children and adolescents for nonoccupational exposure to HIV is likely to be encountered in the ED setting. Guidelines have been established to aid in the decision-making process for the appropriate use of antiretroviral medications for nonoccupational postexposure prophylaxis (nPEP).

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Since human immunodeficiency virus (HIV) infection was first identified in 1981, the epidemic of HIV in the pediatric age group has affected a disproportionate number of infants born to mothers with HIV infection. These infants with perinatal HIV infection were born with what was considered a fatal infection but has now been transformed into a chronic disease. Many of these infants with perinatal HIV infection have now reached adolescence. Decreased rates of hospitalization1 and mortality13 have recently been found in children and adolescents with perinatal HIV-1 infection. The most likely reason for improved survival of children with HIV infection has been the introduction of highly active antiretroviral therapy (HAART), which was first begun in 1996 and by 1999 was being received by almost three-quarters of children and adolescents with HIV infection.1 Decreased rates of hospitalization have also corresponded to an expanded use of HAART. Many children with perinatal HIV infection are diagnosed during infancy or early childhood, but it is possible for the diagnosis to be made later in school age or early adolescence. Up to 25% of perinatally infected children develop severe immunosuppression ...

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