Doctors encounter challenges is diagnosing HIV in children during the first year of life. Infants may have symptoms such as inadequate weight gain, intermittent diarrhea, and pneumonia. Later, symptoms may involve a broad array of health issues, depending on the severity of the HIV.

The source of HIV transmission in children is usually the parent who has birthed them. Exposure to the virus may occur in the womb, during childbirth, or when breastfeeding.

Treatment is the same as for adults with HIV ⁠— antiretroviral therapy (ART). If an infant has a severe case of HIV, the risk of death within the first few months is high even with treatment. Afterward, the likelihood of death drops quickly, and the long-term risk is low.

This article will look at the transmission, symptoms, diagnosis, and treatment of HIV in children. It will also discuss the outlook for children with HIV.

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HIV is a virus that harms the immune system, impairing the body’s ability to fight infections and some types of cancer. Since children do not have fully developed immunity, those with HIV become more severely ill from common pediatric infections than those who are HIV-negative.

Because they cannot fight infections well, children with HIV frequently get the following:

Doctors diagnosed 87 cases of HIV in children younger than 13 in the United States during 2018.

That year, 1,544 children in the U.S. were living with HIV from transmission that happened before, during, or immediately after birth. Of these, 60% were African American.

Globally, approximately 1.7 million children under the age of 15 are living with HIV.

A pregnant person with HIV can transmit the virus to their fetus while it develops in the womb. Transmission from a parent with HIV to an infant may also occur during birth or breastfeeding. Doctors refer to these three routes of HIV spread as perinatal transmission.

In the U.S., perinatal transmission is the most common way children get HIV. Virtually all children contract it through this means, but not every child born to a person with HIV will get the virus.

Prior to 1985, a small number of children contracted HIV through contaminated blood products. Due to routine screening that began at this time, the risk of transmission through blood is now very low.

Additionally, there are no known cases of HIV that have resulted from exposure via:

  • tears
  • saliva
  • sweat
  • casual contact, such as sharing bedding or food
  • toilet seats

Learn more about HIV transmission here.

Below are common symptoms of HIV in infants and children:

Infants up to 1 year of age

In the first year of life, doctors have more difficulty recognizing HIV. Symptoms in infants may include:

Children older than 1 year

Doctors may categorize symptoms in children as mild, moderate, or severe.

Mild symptoms include:

  • swollen lymph nodes
  • swollen salivary glands
  • itchy rash
  • constant or reoccurring ear or sinus infections
  • abdominal swelling

Moderate symptoms include:

  • inflammation and swelling of lung tissue
  • constant or reoccurring diarrhea
  • oral thrush that lasts longer than 2 months
  • inflammation of the liver
  • kidney disease
  • fever that lasts longer than 1 month
  • complicated chickenpox

Severe symptoms include:

Doctors diagnose HIV in infants using different means than those they use to diagnose children older than 18 months.

Infants below 18 months

When a person with HIV gives birth, doctors usually order virologic tests for the infant at the following intervals:

  • within 2 days of birth
  • after 1 or 2 months
  • at 4 or 6 months of age

Infants receive an HIV diagnosis when two different blood samples test positive for the virus.

Children older than 18 months

When fetuses develop within the womb, they receive nourishment from the pregnant parent through the placenta. If the pregnant parent has HIV, the placenta also transfers HIV antibodies to the fetus. For this reason, all infants birthed by a parent with HIV will test positive for the antibodies at birth.

After birth, antibodies for HIV from the birthing parent can remain in the blood for up to 18 months. Once children are over 18 months old, doctors use the HIV antibody test to make a diagnosis.

The standard treatment for HIV is ART. Practitioners recommend this for people of all ages, including children. Experts advocate early treatment, as it can help children live longer, healthier lives.

The dose for children may depend on weight rather than age. Additionally, if a child is too young to swallow a pill, doctors may prescribe the liquid form of ART.

Several factors may affect adherence, which refers to taking the medication consistently. For instance, children may refuse treatment due to an unpleasant taste, or side effects may make them reluctant to take it.

Infants who contract HIV in the womb or during birth have a less positive outlook than those who contract it during breastfeeding. They need ART very quickly to prevent death.

A 2016 study found that in the years following the availability of ART, the risk of death declined greatly. However, the likelihood remains high within the first few months after the start of ART in young children with severe HIV. After this period, the rate of death decreases quickly, and the long-term risk is low.

The study authors noted that suboptimal adherence to ART threatens these high survival rates. Yet even with good adherence, children continue to have a high likelihood of associated illnesses.

Cancer is 5–10 times more common in children with HIV compared with those who are HIV-negative. Infections are another threat, as they are the major cause of death.

HIV in children manifests in health conditions that stem from impaired immunity.

Children with HIV cannot fight disease-causing microbes well, putting them at a higher risk of infections, including pneumonia and meningitis. They also have a higher likelihood of developing cancer.

Doctors treat the condition with ART. It is important to start treatment as early as possible.

Early treatment is particularly critical for infants who contract HIV in the womb or during birth.