Rate of decline of HIV-1 infected children

Infection by HIV-1 in infants progresses more rapidly than in adults and in a different manner. Low birth weight, early decreased CD4+ cell counts and early onset of overt symptoms are predictive of rapid progression.

In a study over 26 months of forty-eight South African children with vertically transmitted HIV-1 infection, it was found that 70% of infected infants showed symptoms by 6 months. The symptoms included lymphadenopathy , failure to thrive and neurological abnormalities. The most frequent findings were diarrhea (78%), pneumonia (76%) and lymphadenopathy (70%). Thrush and pneumonia occurred early in infection but then declined. Diarrhea and neurological abnormalities occurred later and their frequency increased during the study period. Forty four per cent of infected infants were diagnosed with AIDS by one year of age. About a third of infected children died during the study period and three quarters of those deaths were within one year. About two-thirds of infected infants survived into early childhood.

In a study of HIV-infected Italian children in 1995, it was found that the median age for the manifestation of symptoms was 5.2 months with only 6% of children lacking symptoms by five years. Among the symptoms shown by these children in their first year were lymphadenopathy, enlarged spleen and enlarged liver. In addition, during the first year the children exhibited HIV-1 hepatitis and diarrhea. The onset of symptoms was dependent on the number of CD4+ cells in the asymptomatic phase of the infection.

From: The early natural history of vertically transmitted HIV-1 infection in African children from Durban, South Africa. Bobat R, Moodley D, Coutsoudis A, Coovadia H, Gouws E. Ann Trop Paediatr. 1998; 18:187-96 and  Onset of clinical signs in children with HIV-1 perinatal infection. Italian Register for HIV Infection in Children. Galli L, de Martino M, Tovo PA, Gabiano C, Zappa M, Giaquinto C, Tulisso S, Vierucci A, Guerra M, Marchisio P, et al. AIDS. 1995 9:455-61.