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BACKGROUND

Human immunodeficiency virus (HIV) has led to a worldwide pandemic that has exacted a dramatic toll on children, especially in resource-limited countries. It is estimated that approximately 1.8 million children younger than 15 years of age were living with HIV in 2015, the vast majority in sub-Saharan Africa.1 In the same year worldwide, approximately 150,000 children were infected perinatally with HIV and 110,000 children died due to HIV/AIDS (acquired immunodeficiency syndrome).1 In 2014 in the United States there were approximately 9000 children and youth less than 19 years of age living with diagnosed HIV infection.2 In resource-rich countries including the United States, the vertical transmission rate has dropped to less than 2%,3-6 and combination antiretroviral therapy (ART) has diminished mortality and morbidity associated with HIV disease.7-9 The pediatric hospitalist must be familiar with the care of HIV-exposed newborns and HIV-infected children, because the initial diagnosis and management of complications often occur in the hospital setting.

Historically, HIV infection and AIDS were differentiated by the 1987 Centers for Disease Control (CDC) case definition for AIDS surveillance—that is, the presence of opportunistic infections or other so-called AIDS-defining conditions.10 The pediatric classification of the severity of HIV disease was subsequently revised to include infection status, clinical status, and immunologic status (Tables 108-1 and 108-2).11,12 The absolute CD4+ T-cell count and CD4% decline naturally with age until 6 years of age when they stabilize at adult levels (Table 108-2). Thus, a 4 year old HIV-infected child with a prior episode of Pneumocystis jiroveci pneumonia (previously Pneumocystis carinii pneumonia, abbreviated PJP) and a prior CD4 count nadir of 350 cells/mm2 would be categorized as C3.12

TABLE 108-1HIV Infection Status
TABLE 108-2§Clinical and Immunologic Status of Pediatric HIV Infection

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