Acquired immune deficiency syndrome in children. Current problems and therapeutic considerations.

Acquired immune deficiency syndrome (AIDS) in children has until recently been under-reported, since the initial Centers for Disease Control definition of AIDS was restrictive. The case definition has now been revised. Most children with AIDS acquired their infection perinatally and have a parent with established AIDS-related complex or AIDS or belong to a high-risk group. Prior to March 1985, children also acquired human immunodeficiency virus from a contaminated blood product transfusion or from factor replacement for hemophilia. In the United States, AIDS in children occurs predominantly in cities with large populations of intravenous drug users. There are a number of differences between the clinical manifestations of human immunodeficiency virus infection in children compared with adults. For example, recurrent bacterial infection is more common in children, perhaps reflecting the abnormal B cell function that occurs relatively early in the disease course. Certain opportunistic infections (e.g., toxoplasmosis, cryptococcal meningitis) are less common in children than adults. Lymphocytic interstitial pneumonia does not occur in adults but is found in 30 to 50 percent of children. On the other hand, Kaposi's sarcoma and other malignancies are less common in children. Treatment has consisted largely of general supportive care in hospital or at home; this is dependent on the availability and utilization of resources and financial support. However, as anti-retroviral therapy becomes available, studies in children have been initiated. It is hoped that in the future it may be possible to prevent the disease; in the meantime, earlier diagnosis and better therapy are important goals.