How is AIDS transmitted to children What are the signs and stages of the disease

HIV/AIDS is a topic that scares many parents, especially when children are at risk of infection. HIV/AIDS is not just an ordinary disease; it directly affects the immune system, which makes the child’s body weak and significantly reduces their ability to fight off illnesses. In this article from Dalili Medical, we will learn together about the symptoms of the disease in children and its different stages, so every parent can be aware and monitor their child’s health. This knowledge helps parents take the necessary steps at the right time. Recognizing these signs can save your child’s life and make the treatment more effective.

What is AIDS?

AIDS is the advanced stage of infection with the Human Immunodeficiency Virus (HIV). In other words, most people infected with HIV may develop AIDS over time if they do not receive appropriate treatment.

At this stage, the immune system becomes very weak and cannot protect the body well. This makes the person vulnerable to infections and illnesses that usually do not affect people with a healthy immune system.

According to the Centers for Disease Control and Prevention (CDC) in the USA, a person is diagnosed with AIDS when the number of CD4 cells (which are important immune cells) drops significantly, or when they develop opportunistic infections. These are infections that affect people with weakened immunity and do not usually infect healthy individuals.

How many children worldwide are infected with HIV?

According to the latest statistics from 2018, approximately 38 million people worldwide are living with HIV, including about 1.7 million children under the age of 15.

Since 2010, new infections among children have declined significantly by 41%, reflecting major efforts in prevention and treatment. However, unfortunately, only about 54% of infected children receive proper treatment.

In 2018, around 100,000 children died due to AIDS-related illnesses. This alarming figure highlights the importance of awareness and early treatment.

Reports also indicate that about 500 children are newly infected with HIV every day, making it crucial to intensify prevention and treatment programs, especially for mothers and children.

How do children become infected with HIV?

More than 90% of children infected with HIV acquire the virus from their infected mothers. HIV can be transmitted to the child during pregnancy, childbirth, or through breastfeeding.

The more severe the mother's HIV infection is, the higher the risk of transmission to the child. Therefore, monitoring and treating the mother's health during pregnancy is very important to reduce the risk of passing the virus to the child.

How does HIV affect children?

Children’s immune systems are still weak and not fully developed, so children infected with HIV face more severe and harder diseases and symptoms compared to adults.

Even common illnesses such as ear infections or sinusitis are harder for their bodies to fight off. Diseases that commonly appear in children with HIV include:

Ear infections and sinus infections
Sepsis (blood poisoning)
Pneumonia
Tuberculosis (TB)
Urinary tract infections
Intestinal diseases
Skin diseases
Meningitis

In developing countries, illnesses such as tuberculosis, diarrhea, and respiratory diseases are more prevalent among children living with HIV.

How can HIV infection be prevented in children?

The best and most reliable way to prevent mother-to-child transmission of HIV is to start antiretroviral therapy (ART) for the infected pregnant mother as early as possible. This treatment reduces the amount of virus in the mother’s blood, greatly lowering the chances of transmitting the virus to the baby during pregnancy, delivery, or breastfeeding.

Additionally, antiretroviral treatment is given to the baby before and after birth to help the baby’s immune system fight the virus and protect them from infection.

Incubation period of AIDS in children

The incubation period is the time doctors need to monitor the infected child and ensure their health is stable. This period may last from 8 to 10 years to confirm that the virus is under control and the child is receiving proper treatment.

How long can a child infected with AIDS live?

Many studies have confirmed that untreated AIDS can seriously threaten the lives of children. Without appropriate treatment, an infected child may live only 8 to 10 years after infection. Therefore, it is very important to educate parents about adhering to treatment doses and continuously monitoring the child’s health.

How long can a child infected with AIDS live?

If parents take good care of the infected child, especially in the early stages, the child can live a normal and long life, God willing. However, if treatment and follow-up are neglected, the child’s lifespan may be shorter, as determined by God.

Do AIDS symptoms differ in children depending on their age?

Yes, AIDS symptoms vary between children and differ in severity depending on age. Infants and young children tend to show milder symptoms, while older children and adolescents usually experience more severe and impactful symptoms.

How long does a child infected with AIDS live without treatment?

Without treatment, the disease can remain for a long time without clear symptoms, but over time symptoms appear and the immune system weakens significantly, which noticeably reduces the child’s life expectancy.

Where does the AIDS-related rash appear in children?

The rash’s location varies by age. In children, it usually appears on the upper body areas such as the chest and limbs, while in adults, it commonly appears in the genital area and around the abdomen.

How does HIV transmit to children?

HIV is transmitted to children in various ways, mainly:

From mother to child during pregnancy or birth:
This is the most common method, where the virus passes from an infected mother to her fetus in the womb or during delivery, called "vertical transmission."
Through breastfeeding:
If the mother is infected and breastfeeds her baby naturally, the virus can be transmitted through her milk. However, if the mother regularly takes antiretroviral treatment, the risk of infection is greatly reduced.
Through contaminated blood or organs:
Blood transfusions or organ transplants from an infected person can cause transmission, but this is very rare due to strict testing before donation.
Using non-sterile medical equipment:
Such as injections or surgical tools that are not properly sterilized. This is very rare in hospitals that follow health protocols.
Sexual abuse of children:
In rare cases, HIV can be transmitted through sexual abuse by an infected person.

Early Symptoms of HIV/AIDS in Children

In the early stages, symptoms of HIV/AIDS in children can be unclear but may include recurrent signs such as:

Persistent headache
Weakness in bones
Prolonged fever
Fatigue and lethargy
Difficulty walking
General discomfort
Frequent diarrhea (more than once a day)
Excessive sweating
Noticeable weight loss
Various neurological seizures
Enlarged lymph nodes
Recurrent skin infections
Delayed mental and physical growth

These symptoms typically appear between ages 3 and 5 if the child is untreated, affecting about 80% of infected children during this period. Fewer children show symptoms within the first or second year of life. With proper treatment, the disease can be controlled, and the child’s health can improve significantly.

Late Symptoms of HIV/AIDS in Children

More severe symptoms indicating disease progression include:

Fungal lung infections
Rash in the diaper area
Lymphoid interstitial pneumonia
Cytomegalovirus infection

Complications of HIV/AIDS Symptoms in Children

If the child does not receive timely treatment or misses doses, serious complications can arise, weakening the immune system to the point where the child cannot fight even simple infections. This greatly increases the risk of severe illness or death.

Common complications include:

Multiple skin ulcers
Significant weight loss
Persistent fatigue
Painful mouth sores causing difficulty eating
Chronic cough
General tiredness and inability to perform daily activities
Visible skin rash
Enlarged lymph nodes
Difficulty breathing
Memory loss or poor concentration
Genital ulcers

Diseases Associated with HIV/AIDS in Children

Due to their weakened immune systems, children with AIDS are more vulnerable to other infections and diseases, such as:

Pelvic inflammatory disease
Meningitis (inflammation of brain and spinal cord membranes)
Chickenpox
Hepatitis
Shingles (Herpes Zoster)
Various types of pneumonia
Vision disorders that may lead to blindness

Types of HIV in Children and Modes of Infection

HIV in children mainly depends on how the virus is transmitted and disease progression, not different virus types per se:

1. Types of HIV Virus

HIV-1: The most common worldwide, responsible for the majority of adult and pediatric cases, with several subtypes.
HIV-2: Less common, mostly found in West Africa, slower progression, milder symptoms; most children are infected with HIV-1.

2. Modes of Transmission in Children

Vertical Transmission (Mother-to-child):
- During pregnancy (in utero)
- During delivery (contact with blood and fluids)
- Through breastfeeding
Horizontal Transmission (Post-birth, less common):
- Blood or organ transfusions from infected donors
- Use of unsterilized medical instruments
- Sexual abuse (rare cases)

3. Disease Progression Types in Children

Rapid Progressors: Health deteriorates quickly; symptoms appear within the first 2 years if untreated; require urgent care.
Slow Progressors: Immune system controls virus longer; symptoms appear later; with treatment can live near-normal lives.

Stages of HIV/AIDS in Children (Simple Explanation)

Stage 1: Latent Phase (No Clear Symptoms)

Virus present but no obvious symptoms
Immune system still strong
Mild signs like slight lymph node swelling and minor growth delays
Early treatment here can halt disease progression

Stage 2: Mild to Moderate Symptoms

Immune weakening starts
Frequent ear and throat infections
Oral thrush causing pain and eating difficulty
Chronic diarrhea
Noticeable growth delay and weight loss
Loss of appetite

Stage 3: Advanced Symptoms (Full-blown AIDS)

Severe immune suppression
Serious infections like pneumonia or tuberculosis
Severe weight loss (wasting)
Enlarged liver or spleen
Chronic skin diseases
Neurological problems like seizures or cognitive delays
High risk of death without treatment

Are Routine Vaccinations Safe for HIV-Infected Children?

Vaccinations are very important for HIV-positive children to prevent other infections. However, their immune status must be evaluated before vaccination:

Safe Vaccines:
- MMR (measles, mumps, rubella) – safe unless immunity is very weak
- DTaP/Td (diphtheria, tetanus, pertussis)
- Hib (Haemophilus influenzae type b)
- Hepatitis B and A
- Annual flu vaccine (injection only; avoid nasal spray containing live virus)
- Pneumococcal vaccine
- Varicella Zoster Immune Globulin (VZIG) in certain cases

Diagnostic Tests for HIV in Children

Children Under 18 Months

Antibody tests alone are insufficient because maternal antibodies cross the placenta. Direct viral detection tests are used instead:

PCR Test (DNA or RNA): Detects viral genetic material
- Testing timeline: 14 days, 4-6 weeks, 3 months, 6 months
- Two positive results = infection confirmed
- Two negative results after 4 months = likely uninfected
HIV RNA Quantitative Test: Measures viral load for diagnosis and monitoring

Children Older Than 18 Months

Antibody tests become reliable:

HIV Antibody Test (ELISA): Detects antibodies
Confirmatory Tests: Western blot or immunofluorescence assay
Combo Test (p24 antigen + antibodies): Early detection of infection

Additional Post-Diagnosis Tests

Test	Purpose
CD4 Count	Measures immune system strength
HIV Viral Load	Monitors virus amount in blood
Complete Blood Count	Checks for anemia or infections
Liver & Kidney Function	Monitors drug side effects

Important Tips:

Every child born to an HIV-positive mother must undergo tests at precise scheduled times.

Early detection and rapid initiation of treatment significantly impact the child's health and future.

⚕️ When should an HIV test be done for the child?

Testing the child is necessary in the following cases:

The mother is known to be HIV-positive.
The child shows unusual symptoms with unclear causes, such as growth failure, recurrent infections, or persistent fever.
The child has received a blood transfusion under unsafe or non-sterile conditions.
There is suspicion of sexual abuse.
Someone in the household is HIV-positive, and there are insufficient precautions to prevent transmission.

Difference Between HIV and AIDS in Children

Aspect	HIV (Human Immunodeficiency Virus)	AIDS (Acquired Immunodeficiency Syndrome)
Definition	Virus attacking the child's immune system	Advanced stage of HIV infection
Type of condition	Chronic viral infection	Disease caused by severe immune system deterioration
When it appears	Can appear within the first few months after birth	Appears after months or years if untreated
Symptoms	Mild or sometimes unclear symptoms initially	Severe, chronic symptoms like serious infections, weight loss, fungal infections, anemia
Effect on immunity	Gradual weakening of the immune system	Immune system is very weak and vulnerable to any infection
Diagnosis	PCR test or antibody tests depending on child's age	Diagnosis based on symptoms and CD4 cell count
Treatment	Antiretroviral therapy (ART)	Same treatment but may need more medical support for infections and complications
Cure	No cure, but can be controlled with treatment	No cure, but disease progression can be delayed with proper treatment
Can the child live normally?	Yes, if treatment starts early and monitoring is good	The child can live a near-normal life with continuous care and follow-up

How to Prevent HIV/AIDS in Children?

Early Screening of Pregnant Women
All pregnant women should be tested for HIV as part of routine prenatal screening.
If positive, treatment begins immediately to protect the baby during pregnancy and delivery.
Treatment of HIV-Positive Mothers During Pregnancy
The mother takes antiretroviral drugs (ART) regularly throughout pregnancy.
This treatment greatly reduces the chance of virus transmission to less than 1%.
Safe Delivery Methods
In some cases, doctors recommend cesarean section instead of natural birth to reduce transmission risk.
Strict medical precautions are taken during delivery to protect the baby.
Postnatal Prophylactic Treatment for the Baby
The baby receives antiretroviral medication from birth for 4 to 6 weeks, even if the mother is treated, to ensure protection.
Avoid Breastfeeding in Certain Cases
If the mother is HIV-positive, breastfeeding may be avoided because the virus can be transmitted through breast milk, especially if there are skin cracks or infections.
Formula feeding is used as an alternative.
However, in low-resource countries, breastfeeding may be allowed with ongoing maternal treatment as per medical advice.
Regular Testing of the Child
PCR testing is done at 14 days after birth, then at 1, 3, and 6 months.
If all tests are negative, the child is considered uninfected.
Education and Awareness
Educating mothers and families on how to protect their children is essential.
Older children should also be informed about HIV prevention to maintain their health.

What is the Treatment for HIV/AIDS in Children?

Antiretroviral Therapy (ART)
Once the child is confirmed HIV-positive, treatment should start immediately.
ART reduces the viral load (amount of virus in the blood) and strengthens the immune system by preserving CD4 cells.
Regular treatment helps the child live a nearly normal, healthy life and reduces disease complications.

Types of HIV Medications for Children (ART) and How They Are Used

Treatment involves several classes of drugs depending on the child's age and health, often combined for effectiveness and ease of use:

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
They prevent the virus from copying its genetic material inside cells.
Common NRTIs for children:
- Zidovudine (AZT): The first drug used to treat HIV.
- Lamivudine (3TC): Safe and widely available.
- Abacavir (ABC): Important but requires allergy testing before use.
- Tenofovir (TDF or TAF): Used more for older children and adolescents.
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
They block an enzyme crucial for viral replication.
Common NNRTIs for children:
- Nevirapine (NVP): Used for infants but requires monitoring of liver function.
- Efavirenz (EFV): Preferred for older children; may cause side effects like vivid dreams or dizziness.
Protease Inhibitors (PIs)
They block the formation of complete viruses and infection.
Common PIs for young children:
- Lopinavir/ritonavir (LPV/r): Available as syrup or tablets.
  Other PIs for older children:
- Atazanavir (ATV), Darunavir (DRV).
Integrase Strand Transfer Inhibitors (INSTIs)
A newer class that prevents virus entry into cells.
Important drugs:
- Raltegravir (RAL): Suitable from birth, well tolerated.
- Dolutegravir (DTG): Safe and effective for children older than 4 weeks.
Combination Therapy
To reduce pill burden, combinations pack several drugs into one pill or syrup.
Examples:
- ABC/3TC/DTG (three drugs in one pill)
- AZT/3TC/NVP
- LPV/r syrup contains two drugs together.

Dosages for Children:

Doses depend on the child's weight and age.
Available in syrup or small tablets suitable for children.

Monitoring After Starting Treatment:

Regular viral load tests to measure virus amount in the blood.
Monitoring CD4 cell counts to assess immune system strength.
Liver and kidney function tests to check for drug side effects.
Tracking physical and mental growth.
Evaluating any medication side effects continuously.

When Does an HIV-Positive Child Need Surgery?

HIV itself does not have surgical treatment, but complications may require surgery, especially when the immune system is weak:

Abscesses and Deep Skin Infections
The weakened immune system may fail to fight infections, causing abscesses or pus collections that require surgical drainage or cleaning to prevent spread.
Lymph Node Enlargement or Tumors
Rarely, lymph nodes may swell significantly or tumors like Kaposi’s sarcoma may develop. Surgery may be needed to remove or reduce these.
Bone and Joint Problems
Infections or abscesses in bones or joints might require surgical cleaning to protect these structures from damage.
Brain or Nervous System Abscess
Very rare but life-threatening. Surgical intervention is urgent to save the child's life and prevent serious complications.

Care Team for HIV-Positive Children:

Pediatric infectious disease specialists usually manage the viral infection and immune issues.
Surgical teams handle complications needing operations.
Immunologists monitor immune system function.
Dermatologists treat related skin conditions.
Neurologists manage nervous system complications.