EPIDEMIOLOGY AND STATISTIC : HIV-AIDS IN CHILDREN
According to the Centers for Disease Control and Prevention (CDC), the cumulative estimated number of diagnoses of AIDS in children younger than 13 years through 2005 in the United States is 9089. This represents a drop from the 9419 cases reported in 2003. In the United States, the number of new cases of pediatric AIDS is decreasing, mostly because of public health initiatives regarding universal HIV testing for pregnant women and use of zidovudine in infected pregnant women and their newborn infants. In 2005 in the United States, 3764 children younger than 13 years were living with HIV infection, and an estimated 7 children younger than 13 years died from AIDS-related causes that year. These numbers are in stark contrast to what is occurring internationally.
Globally, children outside the United States are not faring as well. Everyday, 1400 children become HIV positive and 1000 children die of HIV-related causes. An estimated 2.3 million children worldwide younger than 15 years are living with HIV/AIDS. In sub-Saharan Africa alone, 1.9 million children are living with HIV/AIDS and more than 60% of all new HIV infections occur in women, infants, or young children. As of 2007, 90% of the newly infected children are infants who acquire HIV from their infected mothers. Alarmingly, 90% of babies who acquire the disease from infected mothers are found in sub-Saharan Africa. The prevalence of HIV infection among undernourished children has been estimated to be as high as 25%.
The prevalence of HIV infection in Asia and Europe varies considerably because of varied cultural practices and lack of a national reporting system in many areas. The commercial sex worker industry in countries such as Thailand and in the Caribbean Islands is responsible for increased HIV transmission to young girls and, vertically, to infants.
In 2004, more than half a million children younger than 15 years died from HIV/AIDS. In 2006, this number decreased to 380,000. In 2002, HIV/AIDS was the seventh leading cause of mortality in children in developing countries. The disease progresses rapidly in approximately 10-20% of children who are infected, and they die of AIDS by age 4 years, whereas 80-90% survive to a mean age of 9-10 years. In affected regions of sub-Saharan Africa, the infant mortality rate has increased by 75% due, in part, to the orphaned status of most children. In contrast to much of the developed world, the mortality rates for children younger than 5 years are higher today than those observed in 1990 in many African countries, mostly because of the devastating effects of HIV/AIDS. A 2006 South African study estimates that HIV/AIDS is the single largest cause of infant and childhood deaths in rural South Africa. HIV/AIDS is now responsible for 332,000 child deaths in sub-Saharan Africa, almost 8% of all child deaths in the region.
In the United States, children from minority communities have been most affected by AIDS. More than 50% of affected children are black, and slightly less than 25% are Hispanic. Of the new childhood HIV cases in 2003, 68% occurred in African Americans. The number of pediatric AIDS cases reported in black non-Hispanic children is 3.4 times higher than in white non-Hispanic children and is 2.6 times higher than that of Hispanic children.
Young people (aged 15-44 y) account for one of the fastest growing infected groups and account for almost half of all infections. Among young people, young women are more likely to become infected. In sub-Saharan Africa, more than two thirds of all youth infected are young girls. Variations in frequencies in the sexes in other regions of the world depend on the predominance of commercial sex workers and the proportion of a transient and mobile workforce more likely to be separated from family.
Because vertical transmission from mother to child is the main route by which pediatric HIV infection is acquired, most children who are HIV positive should be identified in infancy. Vertical transmission can occur in utero, during delivery, and from breastfeeding. Although current treatment strategies can prevent vertical transmission, the drugs are simply not available in many places, especially in Africa.
Because passive transfer of maternal antibodies to the infant occurs, the standard enzyme-linked immunosorbent assay (ELISA) and Western blot tests cannot be used with diagnostic certainty until age 2 years; however, HIV RNA assays and the HIV DNA polymerase chain reaction (PCR) test can be used for early detection. HIV infection can be diagnosed in most infants by age 1 month and in all infants by age 6 months. The use of at least 2 virologic assays is recommended to confirm positive results, with a final exclusion of HIV infection verified by ELISA or Western blot after age 18 months in infants born to mothers who are HIV positive.
- UNAIDS, UNICEF, USAID. Children on the Brink 2004: A joint report of new orphan estimates and a framework for action. UNICEF. Available at http://www.unicef.org/publications/index_22212.html. Accessed 2004.
- UNAIDS, WHO. UNAIDS/WHO AIDS Epidemic Update:. UNAIDS. Available at http://www.unaids.org/en/HIV_data/epi2006/default.asp. Accessed 2006.
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