Congenital HIV

HIV stands for human immunodeficiency virus. HIV is the virus which, when untreated, becomes AIDS, or acquired immune deficiency syndrome. The virus attacks the body's immune system, especially white blood cells called CD-4 cells (also called "T-cells").

Your immune system is what fights against infections to keep your body healthy, and T-cells play a key role in keeping a person protected from infections. If your immune system is weakened, it can't protect your body and you can easily get sick.

AIDS/HIV:

• Can be spread from mother to unborn baby, but the risk of passing the virus to your baby can be reduced
• Cannot be transferred through sweat, saliva, or casual contact with someone who is infected
• Could take years to show symptoms, but internal damage is still happening
• Has no cure, but treatments help prevent the disease from getting worse

Due to advances in anti-retroviral drugs and research breakthroughs by centers like the Boston Children's Hospital AIDS Program (CHAP), the transmission rate from mother to child is currently 1 percent. Between 6,000 and 7,000 children are born to HIV-infected mothers each year in the United States.

Even if there are no symptoms of HIV, the virus is actively infecting and killing cells of the immune system. As the immune system deteriorates, complications begin to develop. Symptoms vary child-to-child depending on age, but may include:

• Lymph nodes that remain enlarged for more than three months
• Lack of energy
• Weight loss
• Frequent and long-lasting fevers and sweats
• Persistent or frequent yeast infections (oral or vaginal)
• Persistent skin rashes or flaky skin
• Pelvic inflammatory disease that does not respond to treatment
• Short-term memory loss
• Frequent and severe herpes infections that cause mouth, genital, or anal sores, or a painful nerve disease known as shingles
• Delayed physical and developmental growth as evidenced by poor weight gain and bone growth
• Swollen abdomen (due to swelling of the liver and spleen)
• Intermittent diarrhea (diarrhea that may come and go)
• Oral thrush (a fungal infection in the mouth that is characterized by white patches on the cheeks and tongue)
• Constant or recurring ear infections
• Swelling of the lung tissue
• Hepatitis
• Chickenpox that may include the digestive track
• Two serious bacterial infections in two years (such as meningitis and pneumonia)
• Yeast infections in the lungs or digestive track
• Kidney disease
• Tumors or malignant lesions

Congenital HIV is the result of the virus spreading to babies born to or breastfed by mothers infected with the virus; however, not every child born to an HIV-infected mother will acquire the virus.

The first step in treating your child is forming an accurate and complete diagnosis.

An HIV-infected child is usually diagnosed with AIDS when his or her immune system becomes severely damaged or other types of infections occur. To determine whether your child has HIV, your doctor will perform different blood tests.

• Early HIV infection must be detected by testing your child's blood for the presence of antibodies (disease-fighting proteins) to HIV. These HIV antibodies generally do not reach levels high enough to detect by standard blood tests until one to three months following infection, and may take as long as six months.
• When a person is highly likely to be infected with HIV, but antibody tests are negative, a test for the presence of HIV itself in the blood is used. Repeat antibody testing at a later date, when antibodies to HIV are more likely to have developed, is often recommended.
• An infant born to an HIV-infected mother may not test positive at birth and it may be necessary for the infant to undergo multiple blood tests at different intervals during her first six months of life.

After we complete all necessary tests, Children’s Hospital Boston’s experts meet to review and discuss what they have learned. Then we will meet with you and your family to discuss the results and outline the best treatment options.

At Boston Children's Hospital, we know how difficult a diagnosis of HIV can be for your whole family. That's why our physicians are focused on family-centered care:

• From your first visit, you'll work with a team of professionals who are committed to supporting all of your family's physical and psychosocial needs. We'll work with you to create a care plan that's best for your child.

As with many other conditions, early detection of HIV offers more options for treatment. Today, there are medical treatments that can slow down the rate at which HIV weakens the immune system, but currently, there is no cure for the disease. However, there are other treatments that can prevent or cure the conditions associated with HIV.

Traditional treatments for AIDS/HIV in pregnant women

• Anti-retroviral drug therapy may be given to a pregnant woman, and has proven to greatly reduce the chance of an infant developing HIV.
• A Cesarean section may be recommended to reduce infant transmission from the birth canal.
• In the United States, where other feeding options are available, an infected mother should be discouraged from breastfeeding her infant.

At Boston Children's Hospital AIDS Program (CHAP), our researchers are studying once-a-day and combination therapies with the goal of simplifying treatment. We're also working to determine the impact of combining strong anti-viral therapy with medications to a co-infection, such as tuberculosis, to make sure drugs continue to be effective when combined. Internationally, our research focuses on preventing transmission, designing pediatric anti-viral treatments, vaccine testing and preventing tuberculosis in children with HIV.

At Children's, we consider you and your child integral parts of the care team and not simply recipients of care. You and your care team will work together to customize a plan of care for your child.

Prevention: The best treatment

Because HIV/AIDS is incurable, the best treatment is avoiding infection.

Here are a few tips for pregnant women to reduce the chances of passing the infection to their babies:

• Take anti-retroviral drugs before giving birth.
• Opt for a Cesarean section.

There is no cure for HIV and AIDS, but advances in medicine allow infants infected with HIV to live longer than ever before.

The Boston Children's Hospital AIDS Program (CHAP) treats congenital HIV in infants. CHAP is New England's largest clinic of its type, treating approximately 130 children, teens, and their families each year. During the past two decades, CHAP has become an international leader in HIV and AIDS care and clinical research. Our services include counseling, testing, diagnosis, treatment, education, mental health services, case management, and referrals.

Research pioneered by our team and others, as well as the success of anti-viral drugs, has transformed the disease from a death sentence to a manageable condition.

• Project Protection: Project Protection at the Martha Eliot Health Center provides pre- and post-HIV testing and counseling. These services are free, confidential and offered by walk-in or appointment. We also provide HIV, STI, and hepatitis prevention education.
• Newborn medicine:At the Division of Newborn Medicine, we specialize in treating babies with a wide range of congenital and acquired conditions. Your baby will be seen by a specially trained team of physicians, nurses, therapists and other health professionals who routinely diagnose and treat newborns with critical illnesses.
• Leading the way in fetal and neonatal care: Babies who have a congenital neurological condition need intense, specialized care. At the Fetal-Neonatal Neurology Program at Children’s, we provide comprehensive evaluation and treatment for these young children. Because newborns’ brains are in a crucial window of rapid development, we identify problems as early as possible and intervene quickly.