Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and makes people more vulnerable to other infections and some cancers.
Human immunodeficiency virus (HIV) infection is caused by the HIV virus, which can be transmitted through unprotected vaginal or anal intercourse, blood transfusion, and contaminated needles and, in infants, can be acquired from the mother during pregnancy, birth, or breastfeeding.
Signs of infection in children include slowed growth, enlargement of lymph nodes in several areas of the body, developmental delay, recurring bacterial infections, and lung inflammation.
The diagnosis is based on blood tests for HIV infection.
Anti-HIV medications (called antiretroviral therapy or ART) can control the effects of HIV infection and allow children to live without complications.
Pregnant people with HIV infection can prevent transmitting the infection to their newborn by taking antiretroviral medications, feeding their newborn formula or donor milk rather than their own milk, and, for some people, undergoing a cesarean delivery.
Pre-exposure prophylaxis (PrEP) is a regimen of one or more medications that greatly reduces the risk of HIV infection in people who do not have HIV infection but who have a high risk of becoming infected.
(See also HIV infection in adults.)
There are 2 human immunodeficiency viruses:
HIV-1
HIV-2
Infection with HIV-1 is by far more common than infection with HIV-2 in almost all geographic areas. Both progressively destroy certain types of white blood cells called lymphocytes, which are an important part of the body's immune defenses. When these lymphocytes are destroyed, the body becomes susceptible to attack by many other infectious organisms. Many of the symptoms and complications of HIV infection, including death, are the result of these other infections and not of the HIV infection itself.
HIV infection may lead to various troublesome infections with organisms that do not ordinarily infect healthy people. These are called opportunistic infections because they take advantage of a weakened immune system. Opportunistic infections may result from viruses, parasites, fungi, and sometimes bacteria.
Advanced HIV infection (also called acquired immunodeficiency syndrome or AIDS) is a severe stage of HIV infection. Children with advanced HIV infection have at least one opportunistic infection or have severe damage to their immune system.
Worldwide, in 2024, about 1.4 million children under 15 years of age had HIV infection, and about 120,000 of those were new infections.
Only about 1% of the people infected with HIV in the United States have been diagnosed as children or young adolescents. HIV infection in children has greatly declined because of greater testing and treatment of pregnant people infected with HIV. Treatment with antiretroviral medications before and during birth can help prevent transmission from mother to child. In 2022, only 62 new cases were diagnosed in children under 13 years of age.
The number of children and adolescents who are newly diagnosed with HIV infection each year in the United States continues to decrease. However, the number of newly diagnosed infections among adolescents and young adults, particularly in young men who have sex with men, has slightly increased in recent years because they are surviving longer. In 2022, more than 38,000 new cases of HIV infection in the United States were diagnosed. Of these new cases, 19% were among adolescents and young adults 13 to 24 years of age (the majority of whom were 20 years of age or older). Males are most affected, making up almost 80% of new cases.
In 2023, in the United States and affiliated territories, there were 4,496 HIV-related deaths among people of all ages. Fewer than 10 of those deaths were children age 13 or older, and only 1 child under 13 years of age died. Worldwide, in 2024, about 75,000 infected children died.
Programs created to deliver antiretroviral therapy (ART) to pregnant people and children in the United States have markedly reduced the annual number of new childhood infections and childhood deaths. However, infected children around the world still do not receive ART nearly as often as adults.
Transmission of HIV Infection
HIV IS transmitted through:
Semen
Vaginal fluids
Rectal fluids
Blood
Human milk (via breastfeeding)
Contaminated needles (used for injecting illicit drugs)
Pregnancy and delivery
HIV is NOT transmitted through:
Food
Water
Air
Touching or using the same items (for example, clothing, furniture, doorknobs, and toilet seats)
Social contact in a home, workplace, or school
Saliva, tears, or sweat
Hugging, coughing, kissing, or shaking hands
Ticks, mosquitoes, or other insects
In very rare cases, HIV has been transmitted by contact with infected blood on the skin or through oral sex. In almost all such cases, the skin surface primarily around the genitals was broken by scrapes, or had open sores; oral sores (for example, mouth ulcers and bleeding or damaged gums) also increase the risk but to a lesser extent.
Although tears, saliva, and sweat may contain the virus, there are no known cases of transmission of infection by coughing or kissing.
Newborns and young children
HIV is most commonly transmitted to children by:
An infected mother before birth or during birth
After birth through breastfeeding (chestfeeding)
The vast majority of children with HIV infection in the United States were infected before or around the time of birth (called vertical transmission or mother-to-child transmission). Most of the remaining children were given contaminated blood or blood products, and a few were infected through sexual abuse.
Because of improved safety measures regarding HIV screening of blood and blood products, in recent years no HIV has been transmitted this way.
About 15 to 40% of people who do not receive ART during pregnancy or breastfeeding will transmit the infection to their baby. Transmission most often takes place during labor and delivery.
The risk of transmission is highest among mothers who:
Acquire HIV infection during pregnancy or while breastfeeding
Are severely ill due to HIV infection
Have more virus in their body
Have a low white blood cell count
However, transmission has declined significantly in the United States from about 25% in 1991 to about 1% in 2024. Mother-to-child transmission has been reduced because of an intensive effort to test and treat infected pregnant people during both pregnancy and delivery.
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The virus also can be transmitted in human milk. Some infants who were not infected at birth acquire HIV infection if they breastfeed from a mother infected with HIV. Most often, transmission occurs in the first few weeks or months of life but may occur later. Transmission by breastfeeding is more likely in mothers who have a high level of virus in their body, including those who acquired the infection while pregnant or during the time period in which they were breastfeeding their infant. However, a mother with HIV infection who is receiving ART and whose blood level of HIV virus is consistently undetectable has a less than 1% chance of transmitting the infection to her infant while breastfeeding.
Adolescents
In adolescents, the ways HIV infection is transmitted are the same as in adults:
Having unprotected vaginal or anal intercourse
Sharing infected needles
All adolescents are at increased risk of HIV infection if they have unprotected sex. Adolescents who share infected needles while injecting drugs are also at increased risk.
Symptoms of HIV Infection in Children and Adolescents
Children born with HIV infection rarely develop infections or other symptoms for the first few months of life even though the virus can weaken their immune system and even if they have not received antiretroviral therapy (ART). If the children remain untreated, symptoms usually develop at about age 3 years, but some children may not develop symptoms until age 5 or older. However, many older infants who remain untreated may first develop serious pneumonia caused by Pneumocystis jirovecii.
The symptoms of HIV infection acquired during adolescence are similar to those in adults (see symptoms of HIV infection in adults).
Children with untreated HIV infection
Most children with HIV infection in the United States and in other high-income countries receive ART. However, if children do not receive ART, common symptoms of HIV infection include:
Slowed growth and a delay of maturation
Enlargement of lymph nodes in several areas of the body
Repeated episodes of bacterial infections (especially lung, ear, and sinus infections)
Recurring diarrhea
Enlargement of the spleen or liver
Fungal infection of the mouth (thrush)
Anemia
Heart problems
Hepatitis
Other opportunistic infections
A variety of other symptoms and complications can appear as the child's immune system deteriorates.
Sometimes older children who have not received ART have repeated episodes of bacterial infections, such as a middle ear infection (otitis media), sinusitis, bacteria in the blood (bacteremia), or pneumonia. Some children with untreated HIV infection develop lung inflammation (lymphoid interstitial pneumonia).
Untreated children commonly have at least one episode of Pneumocystis jirovecii pneumonia (see Pneumonia in People With a Weakened Immune System). This serious opportunistic infection can occur as early as 4 to 6 weeks of age but occurs mostly in infants 3 to 6 months of age who acquired HIV infection before or at birth. Infants and older children with Pneumocystis jirovecii pneumonia typically develop lung inflammation with cough, difficulty breathing, and fever. Pneumocystis pneumonia is a major cause of death among children and adults with advanced HIV infection.
In a significant number of untreated children with HIV infection, progressive brain damage prevents or delays developmental milestones, such as walking and talking. These children also may have impaired intelligence and a head that is small in relation to their body size. Some untreated infected children progressively lose social and language skills and muscle control. They may become partially paralyzed or unsteady on their feet, or their muscles may become somewhat rigid.
Anemia (a low red blood cell count) is common if HIV infection is not treated. It causes children to become weak and tire easily.
A few untreated children can develop heart problems, such as rapid or irregular heartbeat, or heart failure.
Untreated children also commonly develop inflammation of the liver (hepatitis) or inflammation of the kidneys (nephritis).
Cancers are uncommon in children with advanced HIV infection, but non-Hodgkin lymphoma and lymphomas of the brain occur more often than in uninfected children. Kaposi sarcoma is very rare in children infected with HIV.
Children with HIV infection treated with ART
ART has significantly changed the way HIV infection manifests in children. ART is very effective and allows doctors to manage HIV infection as a chronic disease. With ART, children with HIV infection usually do not develop opportunistic infections or have poor growth because of HIV infection.
Although ART clearly lessens the effects of HIV infection on the brain and nervous system, there seems to be an increased rate of behavioral, developmental, and cognitive problems in children with HIV infection who are treated with ART during critical periods of growth and development. It is unclear whether these problems are caused by HIV infection itself, the medications used to treat HIV, or other biologic, psychological, and social factors that are common among children with HIV infection.
Because ART has allowed children to survive for many years, more people living with HIV are developing long-term complications of HIV infection and ART. These complications include obesity, heart disease, diabetes, and kidney disease. These complications may be related to HIV infection itself or to the effects of ART medications.
Diagnosis of HIV Infection in Children and Adolescents
For pregnant people before birth, prenatal screening and testing during labor and delivery
For children after birth, blood tests
For children after diagnosis, frequent monitoring with blood tests
Pregnant people
The diagnosis of HIV infection in children begins with the identification of HIV infection in pregnant people through routine prenatal screening of blood. Women should be tested for HIV infection early in pregnancy and again in the third trimester to detect newly acquired HIV infection.
Rapid tests for HIV using blood or saliva can be done while women are in labor and delivery units at the hospital. These tests can provide results in minutes to hours.
All children under 18 months of age
For all children under 18 months of age, including newborns, standard adult blood tests for HIV antibodies or antigens are not helpful, because the blood of an infant born to a mother with HIV infection almost always contains HIV antibodies passed through the placenta even if the infant is not infected.
So, to definitively diagnose HIV infection in children under 18 months of age, special blood tests called nucleic acid tests (NATs) are done. The diagnosis of HIV infection is confirmed if the NATs detect genetic material from HIV (DNA or RNA) in the child's blood.
Newborns are tested at birth. After that, testing using NATs should be done at frequent intervals, typically in the first 2 weeks of life, at about 1 to 2 months of age, and between 4 months and 6 months of age. Such frequent testing identifies most infants infected with HIV by 6 months of age. Some infants who have a higher risk of developing HIV infection after birth may be tested more frequently. This higher risk group includes infants born to mothers who:
Are at risk of HIV infection
Did not receive prenatal care
Did not receive ART during pregnancy, or received ART only after giving birth
Started ART late in pregnancy (during the late second or third trimester)
Had an unknown or a high level of virus in their body in the 4 weeks before giving birth (particularly if delivery was vaginal)
Had either new or pre-existing HIV infection during pregnancy and during breastfeeding (in which case breastfeeding should be stopped)
Children over 18 months of age and adolescents
For children older than 18 months and adolescents, the same tests for diagnosis of HIV infection in adults may be used. These are usually blood tests that are done to look for HIV antibodies and antigens. (Antibodies are proteins produced by the immune system to help defend the body against attack, and antigens are substances that can trigger an immune response in the body—see Tests That Detect Antibodies to or Antigens of Microorganisms.)
Monitoring
Once HIV infection has been diagnosed in a child, doctors regularly do blood tests at 3- to 4-month intervals to monitor the number of CD4+ lymphocytes (CD4 count) and the number of virus particles in the blood (viral load).
Lymphocytes are a type of white blood cell. The number of CD4+ lymphocytes decreases as HIV infection worsens. If the CD4 count is low, children are more likely to develop serious infections and other complications of HIV, such as certain cancers.
The viral load increases as HIV infection worsens. Viral load helps doctors predict how fast the CD4 count is likely to decrease over the next few years.
The CD4 count and viral load help doctors determine how ill the child is, how effective treatment is likely to be, and whether other medications may be needed to prevent or treat complicating infections.
Treatment of HIV Infection in Children and Adolescents
Antiretroviral therapy (ART)
Ongoing monitoring
Encouraging adherence to treatment
Medications
All children with HIV infection should be given ART medications immediately or as soon as possible, ideally within 1 to 2 weeks of diagnosis. Children are treated with most of the same antiretroviral medications as adults (see Drug Treatment of Human Immunodeficiency Virus (HIV) Infection). However, not all of the medications used for older children, adolescents, and adults are available to infants and young children, in part because some are not available in liquid form.
ART is tailored to the child but is very similar to treatment given to adolescents and adults, mostly because medication regimens for these age groups include the same combinations of 3 antiretroviral medications:
Two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) plus
One integrase inhibitor
Rarely, a non-nucleoside reverse transcriptase inhibitor or protease inhibitor (NNRTI) is given with 2 NRTIs.
Simplified Life Cycle of the Human Immunodeficiency Virus
Like all viruses, human immunodeficiency virus (HIV) reproduces (replicates) using the genetic machinery of the cell it infects, usually a CD4+ lymphocyte.
Medications used to treat HIV infection were developed based on the life cycle of HIV. These medications inhibit the 3 enzymes (reverse transcriptase, integrase, and protease) that the virus uses to replicate or to attach to and enter cells. |
In general, children develop the same types of side effects as adults but usually at a much lower rate.
Monitoring
A doctor monitors the effectiveness of ART by regularly measuring the amount of virus present in the child's blood (viral load) and the child's CD4+ cell count (see diagnosis of HIV infection in children). Doctors routinely do several other laboratory tests and give adolescent girls a pregnancy test.
Increased numbers of virus in the blood may be a sign that the virus is developing resistance to the medications or that the child is not taking the medications. In either case, the doctor may need to change the medications. To monitor a child's progress, the doctor examines the child and does blood tests on the child at 3- to 4-month intervals. Other blood tests and urine tests are done at 6- to 12-month intervals.
Adherence
Adherence is taking medications as directed. Adhering to prescribed ART dosing schedules is extremely important. If children take ART medications less often than they are supposed to, the HIV in their system can rapidly become permanently resistant to one or more of the medications. Yet, it may be difficult for parents and children to follow and adhere to complicated medication regimens, which can limit the effectiveness of therapy. To simplify regimens and improve adherence, tablets containing 3 or more medications may be given. These tablets may need to be taken only once or twice a day. The liquid forms of medications are now better-tasting, which improves adherence.
Adherence to ART may be more difficult for adolescents than for younger children. Adolescents with other chronic diseases such as diabetes or asthma may have difficulty adhering to treatment regimens (see also Children and Youth with Special Health Care Needs). Adolescents want to be like their peers and can feel set apart by their illness. Skipping or stopping treatment may be a way for them to deny having an illness. These and other additional issues that may complicate treatment and reduce adherence in adolescents with HIV infection include:
Low self-esteem
A chaotic and unstructured lifestyle
Fear of being singled out because of illness
Sometimes a lack of family support
Transportation difficulties
Financial limitations
Limited access to health care facilities
In addition, adolescents may not fully understand why medications are necessary when they do not feel ill, and they may worry greatly about side effects.
Despite frequent contact with a pediatric health care team, adolescents who have been infected since birth may fear or deny their HIV infection or distrust information provided by the health care team. Instead of directly confronting adolescents who have poor support systems about the need to take their medications, care teams may help the adolescent focus on practical matters such as how to avoid opportunistic infections and how to obtain information about reproductive health services, housing, and succeeding in school (see Transition to Adult Care).
Preventing opportunistic infections
To prevent Pneumocystis pneumonia, doctors give the antibiotic trimethoprim/sulfamethoxazole to children with HIV infection depending on their age and , doctors give the antibiotic trimethoprim/sulfamethoxazole to children with HIV infection depending on their age andCD4 count (the number of a specific type of blood cell called CD4 lymphocytes) or CD4 percentage (the proportion of total white blood cells that are made up of CD4 lymphocytes). All infants who were born to women with HIV infection are given trimethoprim/sulfamethoxazole beginning at 4 to 6 weeks of age until testing shows they are not infected. Children who cannot tolerate trimethoprim/sulfamethoxazole can be given the medication dapsone, atovaquone, or pentamidine.can be given the medication dapsone, atovaquone, or pentamidine.
To prevent Mycobacterium avium complex infection, doctors give the antibiotic azithromycin or clarithromycin to children with HIV infection who have a significantly impaired immune system depending on their age and , doctors give the antibiotic azithromycin or clarithromycin to children with HIV infection who have a significantly impaired immune system depending on their age andCD4 count. Rifabutin is an alternative antibiotic.. Rifabutin is an alternative antibiotic.
Routine childhood vaccinations
Nearly all children infected with HIV should receive the routine childhood vaccinations, including:
Inactivated polio vaccine (not live)
Inactivated influenza vaccine (not live)
Hepatitis A and hepatitis B vaccines
Pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV)
Nirsevimab is a medication that contains antibodies against respiratory syncytial virus (RSV) and it should be given to infants with HIV whose mother did not receive appropriate Nirsevimab is a medication that contains antibodies against respiratory syncytial virus (RSV) and it should be given to infants with HIV whose mother did not receive appropriateRSV vaccination during pregnancy.
Yearly inactivated or live influenza immunization is also recommended for household members.
Some vaccines containing live bacteria, such as the bacille Calmette-Guérin vaccine (which is used to prevent tuberculosis in some countries outside the United States), or live viruses, such as the oral polio virus vaccine (not available in the United States but still used in other parts of the world), can cause a severe or fatal illness in children with HIV whose immune system is very impaired. However, the live measles-mumps-rubella (MMR) vaccine, live varicella vaccine, and, in some areas of the world, live yellow fever vaccine, live Japanese encephalitis vaccine, and live dengue virus vaccine are recommended for children with HIV infection whose immune system is not severely impaired or who do not have symptoms of HIV infection.
Vaccines may be less effective in children with HIV infection because the virus damages their immune system. Children with HIV infection who have very low CD4+ counts are considered at risk of vaccine-preventable diseases when they are exposed to one (such as measles, tetanus, or varicella) regardless of whether they have received the vaccine for that disease. To boost the immune system and thereby prevent serious or repeat bacterial infections, doctors give these children immune globulin by vein (intravenously). Intravenous immune globulin is a purified solution of antibodies obtained from volunteer donors. Doctors also give intravenous immune globulin or immediate vaccination with measles-mumps-rubella vaccine to unimmunized household members who are exposed to measles.
Social issues
Children with HIV infection should be allowed to attend school without restrictions, and there should be no restrictions regarding foster care, adoption, or child care of children with HIV infection.
How much and when children are told about their illness depends on age and maturity. Older children and adolescents should be made aware of their diagnosis and the possibility of sexual transmission and should be counseled appropriately. Feelings of guilt (especially in older children and adolescents) are common. Anyone in the family who becomes depressed should receive counseling.
Families may be unwilling to share the diagnosis with people outside the immediate family because it can create social isolation and depression among affected children and their family members. Because of the stigma associated with the illness, the routine use of universal precautions in schools and day care centers, and the fact that transmission of the infection to other children is extremely unlikely, there is no need for anyone other than the parents, the doctor, and perhaps the school nurse to be aware of the child's HIV status.
Children with HIV infection should participate in as many routine childhood activities as their physical condition allows. Interaction with other children enhances social development and self-esteem.
Transition to Adult Care in Adolescents with HIV Infection
Once adolescents with HIV infection reach a certain age (typically 18 to 21 years old), they transition from pediatric care to adult care. Adult health care is quite different from pediatric care, and the transition takes time and planning in advance.
Pediatric health care is typically family-centered, and the care team includes a multidisciplinary team of physicians, nurses, social workers, and mental health professionals. Adolescents infected at birth may have been cared for by such a team for their entire life.
In contrast, typical adult health care tends to be individual-centered, and the health care professionals involved may be located in separate offices requiring multiple visits. Health care professionals at adult care clinics and offices are often managing high patient volumes, and the consequences of lateness or missed appointments (which may be more common among adolescents) are stricter.
Planning the transition over several months and having adolescents have discussions or joint visits with the pediatric and adult health care professionals can lead to a smoother and more successful transition.
Prognosis for HIV Infection in Children and Adolescents
Before antiretroviral therapy (ART), about 10 to 20% of children from high-income countries and 60 to 70% of children from low-income countries died before 5 years of age. Today, with ART, most children born with HIV infection live well into adulthood. Increasing numbers of these young adults who were infected at birth have had their own children.
If children with HIV infection do not receive ART, opportunistic infections occur, particularly Pneumocystis pneumonia, and the prognosis is poor. Pneumocystis pneumonia is fatal in 5 to 30% of treated children and nearly always fatal in untreated children. The prognosis is also poor for children in whom HIV is detected early (within the first week of life) or who develop symptoms in the first year of life and do not receive ART.
Because of the way HIV remains hidden within people's cells, medications do not completely eliminate the virus from the body. Even when tests do not detect the virus, some virus remains within cells. To date, there is no cure for HIV infection, and it is not yet known if a cure is possible. What is known, however, is that HIV infection is a treatable infection, and that long-term survival is possible if effective ART is given.
Doctors recommend that ART should not be interrupted at any age.
Prevention of HIV Infection in Children and Adolescents
See also preventive treatment after exposure.
Preventing transmission from infected mother to child
Current preventive therapy for infected pregnant people is highly effective at minimizing transmission. Pregnant people with HIV infection should begin antiretroviral therapy (ART) as soon as HIV infection is diagnosed and they are ready to follow the therapy as directed. Pregnant people with HIV infection who are already on ART should continue the therapy throughout the pregnancy. People with HIV infection should also continue ART when trying to become pregnant.
In addition to ART, the antiretroviral medication zidovudine (ZDV) is given by vein (intravenously) to the mother during labor and delivery. ZDV is then given to the HIV-exposed newborn by mouth twice a day for the first 2 weeks of life (sometimes along with 4 to 6 weeks of additional antiviral medications for certain newborns at greater risk of acquiring HIV infection). Treatment of mothers and children with combinations of ART medications reduces the rate of transmission from 25% to 1% or less. Also, In addition to ART, the antiretroviral medication zidovudine (ZDV) is given by vein (intravenously) to the mother during labor and delivery. ZDV is then given to the HIV-exposed newborn by mouth twice a day for the first 2 weeks of life (sometimes along with 4 to 6 weeks of additional antiviral medications for certain newborns at greater risk of acquiring HIV infection). Treatment of mothers and children with combinations of ART medications reduces the rate of transmission from 25% to 1% or less. Also,cesarean delivery (c-section) done before labor begins may reduce the newborn's risk of acquiring HIV infection. Doctors may recommend cesarean delivery for women whose infection is not well controlled by ART. After delivery, ART is continued for all women with HIV infection.
HIV can be transmitted during breastfeeding and in human milk, but the risk is very low. Mothers who want to breastfeed should have counseling and decision-making discussions with health care professionals.
In countries where the risks of undernutrition and infections are high and where safe, affordable infant formula or pasteurized donor milk from a milk bank is not available, the benefits of breastfeeding may outweigh the risk of HIV transmission. In these countries, mothers with HIV infection who are under medical supervision may continue to breastfeed for at least 12 months of the infant's life. Doctors may decide to give infants ART (for example, nevirapine or lamivudine) throughout the period of breastfeeding. In countries where the risks of undernutrition and infections are high and where safe, affordable infant formula or pasteurized donor milk from a milk bank is not available, the benefits of breastfeeding may outweigh the risk of HIV transmission. In these countries, mothers with HIV infection who are under medical supervision may continue to breastfeed for at least 12 months of the infant's life. Doctors may decide to give infants ART (for example, nevirapine or lamivudine) throughout the period of breastfeeding.
Mothers with HIV infection should not donate their milk to milk banks.
Mothers with HIV infection should not prechew (premasticate) food for infants because there is a rare risk that the mothers' oral secretions contain the virus and could contaminate the food (such as in mothers who have open sores in their mouth or bleeding gums).
Preventing transmission from infected children to others
Because a child's HIV status may not be known, all schools and day care centers should adopt special procedures for handling accidents, such as nosebleeds, and for cleaning and disinfecting surfaces contaminated with blood.
During cleanup, personnel are advised to avoid having their skin come in contact with blood. Latex gloves should be routinely available, and hands should be washed after the gloves are removed.
Contaminated surfaces should be cleaned and disinfected with a freshly prepared bleach solution containing 1 part of household bleach to 10 to 100 parts of water.
These practices are called universal precautions and are followed not only for children with HIV infection but for all children and in all situations involving blood.
Because HIV infection is not spread through saliva or tears, children with HIV infection should be allowed to attend schools and day care centers without restrictions. However, a young child with HIV infection who may be an increased risk to others, for example, a child who has open skin sores or who aggressively bites others, requires special precautions.
Children with HIV infection should be taught good hygiene and behaviors (for example, handwashing, prompt wound care, and taking care to not share personal items such as razors or toothbrushes) that reduce risk to others.
Preventing transmission for adolescents
Prevention for adolescents is the same as prevention for adults.
All adolescents should have access to HIV testing and should be taught how HIV is transmitted and how it can be avoided, including abstaining from high-risk behaviors (such as sharing infected needles) and practicing safer sex. Efforts should be made to include adolescents at high risk of HIV infection, such as Black and Hispanic adolescent men who have sex with men.
Preventive treatment before exposure
Taking an antiretroviral medication before being exposed to HIV can reduce the risk of HIV infection. Such preventive treatment is called pre-exposure prophylaxis (PrEP). PrEP medications include tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), tenofovir alafenamide/emtricitabine (TAF/FTC), lenacapavir, and cabotegravir.). PrEP medications include tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), tenofovir alafenamide/emtricitabine (TAF/FTC), lenacapavir, and cabotegravir.
PrEP is most effective if people take the medication every day or as otherwise instructed, but it can be expensive, so PrEP is recommended most often for people who are not infected with HIV but who have a high risk of becoming infected, such as people (including older adolescents) who have a sex partner who is infected with HIV, men who have sex with men, and people who are transgender. Adolescents at risk of HIV infection may also receive PrEP (especially if they are sexually active), but issues regarding confidentiality and cost may make obtaining PrEP more complex for adolescents than for adults.
People who use PrEP still need to use other methods to prevent other sexually transmitted infections (STIs) or bloodborne infections (for example, hepatitis B and hepatitis C), including consistently using condoms and not sharing needles to inject drugs.
Drugs Mentioned In This Article
