HIV and your child

What is HIV?

HIV stands for human immunodeficiency virus. HIV is a virus that infects certain white blood cells of the immune system. It makes the immune system weaker over time. This puts a person at risk for other serious infections.

How children get HIV

Children can get HIV in the following ways:

• A woman infected with HIV can unknowingly pass it onto their baby during pregnancy, at birth or after pregnancy through breastfeeding. Some women do not know they have HIV until they are pregnant and get tested. If you are HIV-positive and having a baby, please visit our page on HIV and pregnancy. It explains how to lower the risk that your baby will get HIV and how to find out if your baby is infected.
• Some children get HIV through blood or blood products that have HIV in them. This is very rare now as the blood supply in most countries is tested for HIV. Some children also get HIV through contaminated needles or surgical equipment. This usually happens in countries where the blood supply is not tested and surgical equipment and needles are not properly cleaned and sterilized.
• Teenagers having unprotected sex or children who have been abused can become infected with HIV.
• Sharing needles that have been in contact with contaminated blood, such as in drug use, tattooing or body piercing.

What having a child with HIV means to you and your family

If your child has HIV, you should be tested so that you know whether you have HIV (your HIV status). If you are HIV-positive, your other children and sexual partners should also be tested. You should also seek care for yourself so that you can stay healthy to take care of your child and family.

Your child and any family members who are HIV-positive should have regular visits to a clinic that specializes in treating HIV.

Treatments for children with HIV

Two main types of treatment are given to children with HIV:

• medicines to treat the HIV infection
• medicines to prevent other infections.
  

Medicines to treat the HIV infection

Medicines that treat HIV prevent the virus from replicating (making more copies of itself) or entering CD4 cells. These medicines are called antiretrovirals (ARVs). Most of the time HIV treatment consists of taking three or more types of medication. When given in combination, the treatment is often referred to as combination antiretroviral therapy or highly active antiretroviral therapy (HAART). Using HAART decreases the chance that resistance will develop to any one medicine, making the treatment more effective in the long-term. The combination products lower the number of pills needed each day.

To work properly, these medicines must be taken as prescribed, without missing any dose. If your child follows their treatment properly, they can live a healthy, normal life.

Medicines to prevent other infections

Other medicines are given to prevent other infections. These include medications such as trimethoprim-sulfamethoxazole (Septra), which is given to prevent a certain type of serious pneumonia. Not all children need these preventive medicines. They are given only when the child's immune system is too weak to prevent opportunistic infections.

What to expect at your child's HIV clinic appointments

All children should have regular visits to check on their health, usually every one to three months. Your child will be weighed and measured to see how well your child is growing. Your child will be seen by a nurse and one or more doctors to check your child's health since the last visit. Small amounts of blood will be taken to see how your child's immune system is doing, how much virus there is in the blood, and other tests for general health.

Tests to monitor HIV infection

Every three to four months, blood work will be done to assess how your child is doing with the HIV infection. Two tests will be done:

• The viral load will be checked to measure the amount of HIV in the blood. Results are given in copies of viruses (c) per milliliter (pm) of blood (cpm).
• The CD4 cell count will be checked to measure the number of CD4 cells. This test tells the health-care team how well the immune system is doing. The normal number of CD4 cells for a child depends on the age of the child.

People who are available to see you and your child at the clinic

Besides your child's doctors and nurses, here are some other people that you can talk to at the clinic:

• A social worker can talk to you about emotional and family concerns, and how HIV affects your family. The social worker can also help with issues such as money problems, medication costs and immigration issues.
• A dietitian can discuss your child's diet and nutrition needs with you.
• A developmental specialist can talk to you about your child's development and ability to learn in school.
• A physiotherapist may assess your child's overall motor development, such as walking and running.
• A psychiatrist is available to assess your child's self-esteem and whether or not they are ready to be told about HIV.

Many other professionals are available in the hospital, if they are needed. Talk to your child's doctors or nurses about any concerns you have about your child to see if any of these people can help you in the care of your child.

What to do if your child is sick between appointments or you are concerned about their medicines

You should see a family doctor or paediatrician close to your home for regular care.

If you have some questions that can be answered over the phone, call your child's clinic nurse. If your questions are not urgent, you can discuss them at the next appointment.

If other problems need that your child is seen more quickly, either go to the clinic, to your family doctor or paediatrician's office, or even to the emergency department at a hospital close to you.

HIV and your child's health

In Canada, children with HIV can live healthy, normal lives if they go to their clinic regularly for health care and take medicines as prescribed. Many children are diagnosed while they have no or few symptoms. This allows the medical team to start medicines, if needed at that time, to keep the child healthy.

Some children are diagnosed with HIV very late, when they are already very sick from the infection.

Types of problems seen in children with HIV

Before being diagnosed with HIV, some children appear very healthy and do not have any sign of the infection. Other children will have mild problems such as:

• poor growth or weight gain
• skin, chest, ear or gastrointestinal (stomach and intestines) infections
• thrush (white-mouth)
• enlarged glands
  
• diarrhea
• fever
• developmental (physical, emotional and mental) delay.

Other children will have serious problems such as pneumonia, meningitis, tuberculosis, encephalopathy (brain damage) or cancers. Medicine can prevent many of these problems if the HIV infection is found early.

HIV resources

If you have any questions or concerns, contact your child's doctor or the HIV clinic. For more information, check out the following:

• Teresa Group www.teresagroup.ca 416-596-7703
• CATIE: Community AIDS Treatment Information Exchange www.catie.ca