Early clinical signs of HIV in children. Symptoms of HIV infection in children of different ages. Video - HIV Symptoms

Children are the category of people most susceptible to various diseases. Unfortunately, it is the kids who most often suffer from the rash actions of adults and usually endure various diseases more difficult than they do. And children who are carriers of HIV, because of the suppression of the immune system, are more likely than others to suffer from infections and all kinds of diseases. HIV is a disease that is not immediately diagnosed in a baby. What are the symptoms of HIV in children? How to understand that the child needs effective and timely assistance in the fight against this disease?

This disease has become a real plague of the twentieth century, but now it is quite well studied and amenable to some control by doctors and epidemiologists. HIV infection is a disease caused by the human immunodeficiency virus (hence the abbreviation HIV). It usually develops (depending on the situation) rather slowly, affecting certain cells of the immune system, due to which the effectiveness of its work drops to a large extent and a person can die due to the most common disease that a weakened immune system simply cannot cope with.

On a note! Against the background of a weakened immune system, AIDS gradually develops - acquired immunodeficiency syndrome, when the body is simply not able to defend itself against all kinds of infections, which a healthy person copes with very easily.

HIV is a terrible disease, it significantly reduces the life span of a person, if not treated. If the latter is absent, then patients live no longer than 9-11 years from the moment of infection, and in the stage of AIDS, the body "extinguishes" in just 8-9 months. If a certain therapy is carried out, then the life expectancy of a person will be 70-80 years.

The disease is widespread throughout the world, it affects about 34 million people (according to WHO). Modern diagnostic methods make it possible to detect HIV at an early stage - every year more than 2 million people are diagnosed with a disappointing diagnosis, many of which are children - 10 percent or more of the total number of infected people. Unfortunately, the statistics are quite approximate, since many carriers of the infection are not registered and may not even know that they have HIV.

Causes

HIV infection occurs when the causative agent of the disease, the RNA virus, enters the bloodstream. Most often, a person gets sick in three cases:

in case of unprotected intercourse with an infected person;
due to the ingress of the blood of an infected person into the blood of a healthy person;
from a sick woman to a baby during pregnancy, childbirth, breastfeeding.

Attention! When using the same dishes or items of clothing, when shaking hands, HIV cannot be transmitted from person to person!

Children most often acquire HIV from already infected mothers through the bloodstream or through the cervix – the so-called vertical route. Most often, the virus is transmitted from a drug-addicted woman capable of childbearing - about 92% of those infected were infected precisely because of the injection of the drug intravenously through non-sterile instruments.

On a note! Not always a carrier of HIV becomes the mother of a sick child. Such women can give birth to a healthy baby. For example, in the case of prevention, the risk of HIV transmission is only 5-8%.

In general, the probability of HIV transmission from mother to child is about 20% during the gestation period, up to 60% during delivery and 20% during breastfeeding.

Sometimes children get sick in the case of organ transplants, the use of insufficiently sterile equipment in the hospital. The cause of infection can also be the contact of damaged skin with some fluids of a sick person.

Pathogenesis

The causative agent of HIV, after entering a healthy organism, immediately takes root into the cells, where its further development takes place. Usually these are lymphocytes, monocytes, megakaryocytes, some brain cells, cells of the internal tissue of the intestine, and others. The virus affects the work of the nervous and immune systems, changing them. At an early stage of development, it is in the nervous system - at this time it is easy to detect when examining brain tissue. Gradually, the work of the immune system becomes worse, it no longer reliably protects the child's body, which is why the virus develops and spreads more and more actively - neurological disorders progress. Encephalitis develops, problems in the work of the hematopoietic system are noted.

Diagnosing HIV without special tests in the early stages is not easy. In newborns, the disease practically does not manifest itself in any way - this is due to the physiological characteristics of the organism inherent in this age. In rare cases, in babies (only 10-20%), enlarged lymph nodes can be noted. In general, before the age of 3 years, HIV is usually impossible to determine. Unfortunately, if the first symptoms of the disease were noted in the first year of life, then the child dies within just a few months.

However, sometimes the symptoms characteristic of this disease help to alert and respond in time. The main signs of the disease in the neonatal period:

in HIV-carrying mothers, children are often born prematurely and have intrauterine growth retardation, low weight;
babies can have various infections. It can be herpes, hepatitis, syphilis and others;
an increase in lymph nodes is one of the main signs of the disease. During palpation, they are painless, but are up to 0.5-1 cm in size. Enlarged nodes can be observed for up to 3 months or more, while acute inflammatory processes may not be observed;
another early symptom is an increase in some internal organs, in particular, the liver and spleen;
children also have physical problems - body weight is added slowly, which is associated with increased energy consumption of a small organism, metabolic disorders and the frequent occurrence of infectious diseases;
sometimes children not only do not gain weight, but also lose it - up to 10% of body weight;
fever and diarrhea may last for a month or longer;
the skin of babies is prone to the development of various diseases on it, including fungal, viral, bacterial. Children are prone to dermatitis, rashes;
the respiratory system also suffers - pneumonia can develop;
HIV-infected children suffer from heart failure and have poor appetite.

Symptoms of HIV in babies include the presence of lesions of the central nervous system, kidney failure, and the presence of anemia. Such children suffer from acute respiratory viral infections, often occurring with complications. Often with relapses, diseases such as meningitis, otitis, sinusitis occur.

On a note! Contrary to popular belief, the development of tumors in children with HIV is practically not observed. Typically, such processes are observed only in the AIDS stage, since in this case there is a weakened immune system as much as possible.

Also, children aged 6-24 months begin to lag behind in mental development, their memory processes are disturbed, absent-mindedness appears, problems with coordination, muscle weakness - HIV encephalopathy develops.

Table. Stages of HIV encephalopathy.

Stage	Symptoms
	Motor skills are normal, as well as intelligence. There are minimal symptoms of motor dysfunction. In general, all reflexes are normal.
	There are violations of motor processes, intelligence is reduced, but the symptoms are mild. At this stage, 2 or more of the following signs are noted: enlarged spleen, lymph nodes, liver, mumps, dermatitis, acute respiratory viral infections with relapses.
	Children cannot do their homework and cope with household chores for a long time, but they can take care of themselves. Anemia is noted, the number of platelets, leukocyte-neutrophils in the blood decreases, pneumonia, meningitis, candidiasis develop, sepsis may occur. There are problems in the work of the heart muscle, bronchitis, toxoplasmosis, stomatitis develop. Diarrhea may occur.
	Intelligence is significantly reduced, motor processes become inhibited, the child cannot walk.
	The last, terminal stage, when the child is no longer able to communicate with other people and understand something. There are paralysis, serious infections of a bacterial nature.

Video - HIV Symptoms

Diagnostics

Currently, highly sensitive and specific tests are used to diagnose HIV in newborns. But usually doctors decide to test for antibodies to the virus. The analysis is called ELISA - enzyme immunoassay, is performed in a laboratory. If the result is positive, then the blood serum is studied using the immune blotting technique, which makes it possible to detect the presence of HIV antibodies.

Attention! The absence of antibodies in this case cannot completely exclude the presence of HIV. Therefore, if a disease is suspected, studies are carried out aimed at identifying RNA virus particles. The analysis is carried out after 2 months of the baby's life.

Neuropsychological tests are also carried out. MRI can be a good help in diagnosing morphological problems of the brain.

In babies, HIV is diagnosed in three ways:

cultivation, which allows you to detect HIV in babies older than 1 month. In the first time after birth, the accuracy of the method decreases from 90 to 50%. The method is expensive and complicated, therefore it is carried out only in special centers;
nucleic acid determination. Suitable for children older than 1 month - the sensitivity of the method in this case is 98%;
antigen detection. Less sensitive but cheaper way to detect HIV.

If HIV is detected in a child, the baby will be constantly monitored by a doctor. Serological monitoring will be carried out for life every six months.

Treatment

It is impossible to achieve a complete cure for HIV, but with the support of the body, a person’s life is not shortened. Treatment involves the control and support of the child's immune system, the control of diseases that develop against the background of HIV. It also includes conversations with a psychologist and social adaptation, since not everyone around is calm about HIV-infected people.

Children in whom HIV is not defined, but it is assumed, are prescribed from the age of 1-1.5 months for the prevention of pneumonia. You need to take certain medications. If the child is infected, then he is prescribed antiretroviral therapy. It is also necessary to take etiotropic drugs that have the ability to reduce the reproductive ability of the virus.

On a note! Combinations of various antiviral drugs have the maximum effect in the treatment of HIV. And the earlier treatment is started, the more effective it will be.

HIV treatment can be divided into the following points.

Step 1. In the event of various diseases, it is necessary to carry out symptomatic treatment at home. For example, if an irritating dry cough is noted, then someone from the household is asked to fold their palms in handfuls (“ladle”) and, standing behind the patient, pat them on the chest from the bottom up for 3-5 minutes. At the same time, it is impossible to clap on the solar plexus, along the spine, and collarbones.

Step 2 If the temperature rises above 38 degrees, it is recommended to take paracetamol or acetaminophren. The tablets are taken every 4 hours in doses of 500 mg. More than 3500 mg of drugs should not be taken.

Step 3 To avoid depression and withdrawal from society, you should join a support group where you can find friends.

Step 4 Proper nutrition is the key to health and prevention of various diseases. It is important to follow a healthy diet, consuming the required amount of proteins, fats, carbohydrates. It is necessary to eat fruits and vegetables - they, due to the large amount of vitamins, help maintain immunity.

Step 5 You should play sports. Physical education strengthens muscles, bones, ligaments, makes the body stronger, improves immunity. Namely, this is what the HIV patient lacks. It is recommended to combine both cardio and strength training.

Step 6 You should give up bad habits - smoking and drinking alcohol. Substances such as nicotine and alcohol reduce immunity and harm the body. There is a risk of developing pneumonia and liver disease, which is unacceptable in the presence of HIV.

Step 8 Vaccination is a good way to protect yourself from certain diseases. Therefore, vaccinations are a must.

Step 9 It is important for HIV patients to know what antiretroviral therapy is. It consists in taking drugs that increase and stimulate the immune system.

Step 10 Such therapy includes the use of nucleoside reverse transcriptase inhibitors - NRTIs. The HIV virus is capable of incorporating an enzyme into human DNA that can hack human cells in a special way and create new ones, but already affected by HIV. NRTIs will help fight this. As effective drugs, doctors recommend taking Zidovudine and Lamivudine.

Step 11 It is also necessary to take protease inhibitors, which will help block the HIV protease and prevent the development of the disease. These can be drugs such as Amprenavir, Idinavir, Saquinavir, etc.

Step 12 Non-nucleoside reverse transcriptase inhibitor (NNRTI) treatment is also recommended for HIV patients, as NRTI treatment is associated with a host of side effects. NNRTI is an alternative treatment. Drugs in this category: Nevirapine, Evavirenz.

Step 13 In the case of pneumonia, you should not wait for deterioration - it is recommended to immediately start taking antibiotics (Ethambutol, Azithromycin, etc.). But the possibility of taking medications should be discussed with the doctor and not used on their own. Especially when it comes to treating children.

Step 14 It is also important to start treating fungal infections if they occur. It is recommended that certain medications be taken immediately. For example, Fluconazole, Nystatin.

Prevention measures

Children born to HIV-infected mothers must undergo prophylaxis. At the same time, measures are taken regardless of whether the mother had treatment during gestation and childbirth. Antiviral drugs are prescribed to babies from the 8th hour of life only by a pediatrician or neonatologist. The main thing is to start prevention no later than 72 hours from the moment of birth. Babies are prescribed chemoprophylaxis a little later.

A pregnant carrier of HIV from 24-28 weeks of pregnancy is prescribed antiviral therapy. If prevention started late, then it is recommended to carry out a caesarean section, and breastfeeding will be prohibited - the child is raised on mixtures.

It is important to remember that all medications children will have to take throughout their lives.. And the more effective the therapy will be, the more accurately the recommendations of doctors will be followed.

HIV infection is a real scourge of the modern world. It is spread all over the globe, affecting the young, able-bodied part of the planet's population.

The danger also lies in the fact that often people do not suspect that they have this disease, and, being its carrier, contribute to its further spread.

Unfortunately, HIV is diagnosed not only in adults, but also in newborns - most often it is transmitted to the baby from the mother. If a parent “rewarded” a child with an infection or he got it in another way, then the first symptoms of HIV appear, on average, up to 3 years of age.

When, when the disease develops rapidly up to one year, the baby dies in a few months.

When a child is infected at a later age, the incubation period, that is, hidden, lasts 5 years, and life expectancy can be about three years after that, if no action is taken.

Why HIV develops

HIV is the abbreviation for the condition caused by the human immunodeficiency virus. It is accompanied by a decrease in immunity, and, against this background, the development of various infections, malignant tumors, etc.

The spreader of this virus can be a person with AIDS(acquired immunodeficiency syndrome provoked by HIV infection), or its carrier. In nature, the source of this virus are chimpanzees.

The virus can stay in the human body for several years without causing any symptoms. AIDS is the last stage of the disease. It is characterized by the appearance of various complications, which ultimately lead to death.

The causative agent is found in all biological fluids of the body: blood, saliva, tears, breast milk, cerebrospinal fluid, secretion of the sex glands. Once in the human body, the immunodeficiency virus destroys the cells responsible for immunity: lymphocytes, macrophages. Reproducing, it causes their death, then penetrates into the blood, and with its current enters other parts and systems of the body.

At first, the human body is able to compensate for the losses by forming new cells. But over time, his strength is lost, the immune system is depleted and the infected person becomes susceptible to various infections. It is they who cause death in AIDS.

Main routes of transmission:

sexual;
with blood - injections, blood transfusions, dental interventions, salon manipulations (piercing, tattoos, manicure);
from an infected mother to a fetus;

The risk of developing the disease increases in people with non-traditional orientation, drug addicts.

How does infection occur in newborns?

A child becomes infected with HIV in such cases:

in utero- through the placenta, cervix or fetal membranes;
due to physiological birth, especially if there is a perineal incision;
during breastfeeding through contaminated milk;
through raw tools, damage to the skin;
during manipulations related to blood- organ transplantation, blood transfusion.

The earlier a child becomes infected, the more severe and faster the disease progresses.

It is very important that an HIV-infected mother takes appropriate specific therapy during pregnancy. This will reduce the risk of the child's illness to a minimum.

First signs and later

The human immunodeficiency virus multiplies rapidly in the blood, but when it enters the environment, it is destroyed after 20 minutes. Also, this pathogen is sensitive to high temperatures: at 60 ° its properties are significantly reduced, and at 80 ° it dies.

The incubation period, that is, the time from the moment the virus enters the body to the development of the first signs of HIV infection, ranges from a couple of months to 10 years. It all depends on the age at which the child was infected. After the incubation period, the disease begins to develop quite quickly.

Common symptoms of HIV at an early stage in children have such manifestations:

Increase in body temperature. Its values can be up to 38° or higher. This is the body's response to the introduction of viruses, because it is used to the fact that they die at high degrees. But not in this case. Hyperthermia can persist for up to 4 weeks.
Enlarged lymph nodes.
Increased sweating.
Enlarged liver and spleen.
Respiratory effects, rash.
Changes in blood tests.
Often an early manifestation of HIV in children is neuroAIDS, that is, disorders of the nervous system. Based on which department is involved in the process, there are:
- with disorders of the central nervous system: encephalopathy: characterized by a decrease in the ability to remember, impaired movement, muscle weakness, small contractions, decreased mood, lethargy, fatigue.
- encephalitis - the disease begins with mild symptoms: forgetfulness, movement disorders, muscle weakness, poor emotions. Then join the rise in body temperature to high rates, loss of consciousness, convulsions.
- meningitis - in the foreground - headaches, less often nausea, vomiting. Characterized by fever, weight loss, fatigue. Muscular symptoms may develop: inability to bring the head to the chest, muscle stiffness.
- when the spinal cord is damaged, myelopathy is observed - they are manifested by weakness in the legs, which is first replaced by partial, and then by complete immobility. There are malfunctions in the work of the pelvic organs, a decrease in sensitivity;
- with damage to the peripheral parts of the nervous system, polyneuropathy develops - immobility, a decrease in the volume of the muscles of the limbs on both sides.

In newborns, signs of damage to parts of the nervous system can appear from 2 months. The main features include:

convulsions;
increased tone of the arms and legs both at rest and during movement;
incoordination of muscle movements;
impaired mental function; underdevelopment of brain regions.

Early signs in children may be absent, and the disease begins to manifest itself immediately from the first stage.

The main symptoms of HIV in children of different ages are almost the same, but there are some features.

Newborns with HIV infection are usually born prematurely or with low birth weight. The presence of intrauterine infection is also characteristic: herpes, cytomegalovirus and others. Subsequently, these children do not gain weight well. The appearance of the child is also characteristic: a protruding forehead, a shortened nose, strabismus or their protrusion, a blue tint of the sclera, puffy lips, a clearly defined pit above them, developmental defects: cleft palate, cleft lip.

Other signs of the immunodeficiency virus may appear in children infected in utero or during childbirth, between 3 and 9 months.

These symptoms include:

Disorders of mental and physical development: such children start walking, sitting late, the level of psychomotor development also does not correspond to the norm.
Poor weight gain, low growth.
Lymphadenopathy is an enlargement of the lymph nodes.
Increase in body temperature up to 38 °.
Enlargement of the liver, spleen.
Skin lesions: fungal, bacterial infections, dermatitis, rashes in the form of bubbles.
Oral infections in the form of aphthous stomatitis. It manifests itself in the form of ulcers on the mucous membrane.
Violations in the work of the heart, kidneys, respiratory organs.
Disruptions in the digestive system: poor appetite, nausea, vomiting, bloating.
CNS disorders.
Such children very often suffer from infectious diseases that are difficult and long-term.
In rare cases, cancer develops.
Changes in blood tests: anemia, a decrease in the level of leukocytes and platelets.

These symptoms are also characteristic of older children. The ways of infection for them can be organ transplantation, blood transfusion, injections, sexual contacts.

People with HIV infection live an average of 10 years. It should be noted that there are people who are immune to the HIV virus due to the presence of a certain immunoglobulin A in them.

Stages of the disease

As already mentioned, the first stage of HIV in children is latent and can last up to 10 years.

It is also called chronic lymphadenopathy, since its main symptom is an increase in lymph nodes. It is generalized increase at least 2 groups of nodes, and located to the waist: in the chin area, near and behind the ears, above and below the collarbone, on the back of the head and in the neck area. But also inguinal, femoral, popliteal lymph nodes can be involved in the process, their sizes reach 1 cm, they are affected symmetrically on both sides. When probing the nodes, there is no pain. They are not associated with nearby tissues, the skin over them is not changed.

When these symptoms appear, it is necessary to exclude the development of other pathological processes.

The main criterion is persistent lymphadenopathy - for 3 months. This sign is one of the main symptoms of HIV infection.

Also, this stage is characterized by fever, sweating, malaise, weak weight gain.

Stage 2 of the disease or acute stage is characterized by pronounced symptoms.

Symptoms of the acute stage of HIV include:

Constant hyperthermia, enlarged lymph nodes.
Night sweats.
Gastrointestinal disorders - nausea, vomiting, diarrhea.
Sharp weight loss.
Children often suffer from infectious diseases: bronchitis, pneumonia, otitis media, SARS.
Fungal, bacterial lesions of the skin, mucous membranes: rash, stomatitis, purulent elements.
Disorders of the nervous system: meningitis, encephalitis, dementia.
Blood poisoning.

The final stage of the disease - AIDS itself, is accompanied by damage to all organs and systems, severe diseases of the skin and mucous membranes, impressive weight loss due to malfunctions in the digestive system, and the addition of a secondary infection.

The leading symptoms of the last stage of HIV infection are opportunistic and oncological diseases, that is, those that develop as an associated infection with HIV due to reduced immunity. These can be infections caused by the herpes virus, Epstein Bar, cytomegalovirus, as well as tuberculosis, pneumonia.

In children, the most common of these diseases are:

Pneumocystis pneumonia. Affects children 1 year of age. The causative agent is pneumocystis. The disease is characterized by the formation of infiltrates in the lungs and is accompanied by the following symptoms:
- obsessive unproductive cough;
- temperature increase;
- rapid breathing;
- weakness, increased sweating at night.
Interstitial pneumonia. This disease is typical only for childhood, begins imperceptibly and has a sluggish course. Has a non-infectious nature. Accompanied by the formation of infiltrates from the cells of the immune system. Main symptoms:
- shortness of breath, rapid increase in respiratory failure;
- cough without sputum;
- signs of lack of oxygen.

Of the oncological diseases in children, Kaposi's sarcoma and brain tumors can develop, but this is extremely rare.

The course of the end stage of AIDS is quite severe.. The death of a child occurs from an attached infection.

Diagnostics

Diagnosing children for HIV can be carried out even in the prenatal period. To do this, examine the amniotic fluid or take a biopsy of the chorion. But these methods are quite traumatic.

It is difficult to confirm the presence of the disease in newborns born to HIV-positive mothers. The thing is that at birth, their blood contains maternal antibodies, which disappear only by 18 months, and only in rare cases can they leave earlier. In this regard, it is possible to establish or refute the diagnosis for these children no earlier than at 1.5 years.

Currently there is a PCR method that allows you to isolate the DNA of the virus. This is a rather sensitive method, thanks to which it is possible to conduct an examination already in the first two days after birth. If the test result is positive, it is repeated in 1-2 months.

The second positive result confirms the presence of HIV infection in such cases:

if 1 result was negative and the second positive, this also indicates the presence of an infection;
if the first 2 examinations gave a negative result, the next one is carried out at the age of 4 months by other methods - enzyme immunoassay and immune blotting;
if the diagnosis is not confirmed, it is carried out at 6, 9, 12, 15, 18 months. If the results are negative 2 times in a row, the diagnosis is removed.

In older children, HIV can be detected 2 weeks, 3 and 9 months after infection.

Laboratory tests are the first step in the diagnosis of HIV infection. But they also play a role here:

clinical manifestations;
collection of data indicating the possibility of infection;
X-ray data, MRI.

The diagnosis of AIDS cannot be based on a single examination. This requires a series of tests with a certain interval of time. Also, do not forget about the possibility of a false positive reaction. This is mainly due to errors in the test. Therefore, you should trust only proven laboratories and do not conduct a test at home, although this option is also possible.

Treatment

Despite the large amount of research on AIDS, Unfortunately, no cure has been found for it..

But there is antiretroviral therapy that can prevent the development of the disease in children born to HIV-positive mothers. These drugs slow down the replication of the virus.

The condition for positive treatment is the intake of a complex of such drugs by pregnant women and a child after birth.

In infected children, HIV treatment is reduced to the treatment of concomitant diseases, to symptomatic treatment.

AIDS is a severe and deadly disease. And doubly sadder when it affects the younger strata of the population. Therefore, the opposition to this disease should begin, first of all, with prevention and dissemination of knowledge about it.

HIV infection is a real scourge of the modern world. It is spread all over the globe, affecting the young, able-bodied part of the planet's population.

The danger also lies in the fact that often people do not suspect that they have this disease, and, being its carrier, contribute to its further spread.

When, when the disease develops rapidly up to one year, the baby dies in a few months.

When a child is infected at a later age, the incubation period, that is, hidden, lasts 5 years, and life expectancy can be about three years after that, if no action is taken.

Why HIV develops

The spreader of this virus can be a person with AIDS(acquired immunodeficiency syndrome provoked by HIV infection), or its carrier. In nature, the source of this virus are chimpanzees.

Main routes of transmission:

sexual;
with blood - injections, blood transfusions, dental interventions, salon manipulations (piercing, tattoos, manicure);
from an infected mother to a fetus;

The risk of developing the disease increases in people with non-traditional orientation, drug addicts.

How does infection occur in newborns?

A child becomes infected with HIV in such cases:

in utero- through the placenta, cervix or fetal membranes;
due to physiological birth, especially if there is a perineal incision;
during breastfeeding through contaminated milk;
through raw tools, damage to the skin;
during manipulations related to blood- organ transplantation, blood transfusion.

The earlier a child becomes infected, the more severe and faster the disease progresses.

It is very important that an HIV-infected mother takes appropriate specific therapy during pregnancy. This will reduce the risk of the child's illness to a minimum.

First signs and later

Common symptoms of HIV at an early stage in children have such manifestations:

Increase in body temperature. Its values can be up to 38° or higher. This is the body's response to the introduction of viruses, because it is used to the fact that they die at high degrees. But not in this case. Hyperthermia can persist for up to 4 weeks.
Enlarged lymph nodes.
Increased sweating.
Enlarged liver and spleen.
Respiratory effects, rash.
Changes in blood tests.
Often an early manifestation of HIV in children is neuroAIDS, that is, disorders of the nervous system. Based on which department is involved in the process, there are:
- with disorders of the central nervous system: encephalopathy: characterized by a decrease in the ability to remember, impaired movement, muscle weakness, small contractions, decreased mood, lethargy, fatigue.
- encephalitis - the disease begins with mild symptoms: forgetfulness, movement disorders, muscle weakness, poor emotions. Then join the rise in body temperature to high rates, loss of consciousness, convulsions.
- meningitis - in the foreground - headaches, less often nausea, vomiting. Characterized by fever, weight loss, fatigue. Muscular symptoms may develop: inability to bring the head to the chest, muscle stiffness.
- when the spinal cord is damaged, myelopathy is observed - they are manifested by weakness in the legs, which is first replaced by partial, and then by complete immobility. There are malfunctions in the work of the pelvic organs, a decrease in sensitivity;
- with damage to the peripheral parts of the nervous system, polyneuropathy develops - immobility, a decrease in the volume of the muscles of the limbs on both sides.

In newborns, signs of damage to parts of the nervous system can appear from 2 months. The main features include:

convulsions;
increased tone of the arms and legs both at rest and during movement;
incoordination of muscle movements;
impaired mental function; underdevelopment of brain regions.

Early signs in children may be absent, and the disease begins to manifest itself immediately from the first stage.

The main symptoms of HIV in children of different ages are almost the same, but there are some features.

Other signs of the immunodeficiency virus may appear in children infected in utero or during childbirth, between 3 and 9 months.

These symptoms include:

Disorders of mental and physical development: such children start walking, sitting late, the level of psychomotor development also does not correspond to the norm.
Poor weight gain, low growth.
Lymphadenopathy is an enlargement of the lymph nodes.
Increase in body temperature up to 38 °.
Enlargement of the liver, spleen.
Skin lesions: fungal, bacterial infections, dermatitis, rashes in the form of bubbles.
Oral infections in the form of aphthous stomatitis. It manifests itself in the form of ulcers on the mucous membrane.
Violations in the work of the heart, kidneys, respiratory organs.
Disruptions in the digestive system: poor appetite, nausea, vomiting, bloating.
CNS disorders.
Such children very often suffer from infectious diseases that are difficult and long-term.
In rare cases, cancer develops.
Changes in blood tests: anemia, a decrease in the level of leukocytes and platelets.

These symptoms are also characteristic of older children. The ways of infection for them can be organ transplantation, blood transfusion, injections, sexual contacts.

People with HIV infection live an average of 10 years. It should be noted that there are people who are immune to the HIV virus due to the presence of a certain immunoglobulin A in them.

Stages of the disease

As already mentioned, the first stage of HIV in children is latent and can last up to 10 years.

When these symptoms appear, it is necessary to exclude the development of other pathological processes.

The main criterion is persistent lymphadenopathy - for 3 months. This sign is one of the main symptoms of HIV infection.

Also, this stage is characterized by fever, sweating, malaise, weak weight gain.

Stage 2 of the disease or acute stage is characterized by pronounced symptoms.

Symptoms of the acute stage of HIV include:

Constant hyperthermia, enlarged lymph nodes.
Night sweats.
Gastrointestinal disorders - nausea, vomiting, diarrhea.
Sharp weight loss.
Children often suffer from infectious diseases: bronchitis, pneumonia, otitis media, SARS.
Fungal, bacterial lesions of the skin, mucous membranes: rash, stomatitis, purulent elements.
Disorders of the nervous system: meningitis, encephalitis, dementia.
Blood poisoning.

In children, the most common of these diseases are:

Pneumocystis pneumonia. Affects children 1 year of age. The causative agent is pneumocystis. The disease is characterized by the formation of infiltrates in the lungs and is accompanied by the following symptoms:
- obsessive unproductive cough;
- temperature increase;
- rapid breathing;
- weakness, increased sweating at night.
Interstitial pneumonia. This disease is typical only for childhood, begins imperceptibly and has a sluggish course. Has a non-infectious nature. Accompanied by the formation of infiltrates from the cells of the immune system. Main symptoms:
- shortness of breath, rapid increase in respiratory failure;
- cough without sputum;
- signs of lack of oxygen.

Of the oncological diseases in children, Kaposi's sarcoma and brain tumors can develop, but this is extremely rare.

The course of the end stage of AIDS is quite severe.. The death of a child occurs from an attached infection.

Diagnostics

Diagnosing children for HIV can be carried out even in the prenatal period. To do this, examine the amniotic fluid or take a biopsy of the chorion. But these methods are quite traumatic.

The second positive result confirms the presence of HIV infection in such cases:

if 1 result was negative and the second positive, this also indicates the presence of an infection;
if the first 2 examinations gave a negative result, the next one is carried out at the age of 4 months by other methods - enzyme immunoassay and immune blotting;
if the diagnosis is not confirmed, it is carried out at 6, 9, 12, 15, 18 months. If the results are negative 2 times in a row, the diagnosis is removed.

In older children, HIV can be detected 2 weeks, 3 and 9 months after infection.

Laboratory tests are the first step in the diagnosis of HIV infection. But they also play a role here:

clinical manifestations;
collection of data indicating the possibility of infection;
X-ray data, MRI.

Treatment

Despite the large amount of research on AIDS, Unfortunately, no cure has been found for it..

But there is antiretroviral therapy that can prevent the development of the disease in children born to HIV-positive mothers. These drugs slow down the replication of the virus.

The condition for positive treatment is the intake of a complex of such drugs by pregnant women and a child after birth.

In infected children, HIV treatment is reduced to the treatment of concomitant diseases, to symptomatic treatment.

HIV (human immunodeficiency virus) in children occurs when a virus enters the body, causing a persistent pathological weakening of the immune system. It was first described by the French scientist L. Montagnier in the 90s of the XX century. Based on the data of a virologist, one can understand the nature of the occurrence of HIV. This virus has a complex structure, which is resistant to various kinds of influences and has a high degree of variability.

According to the results of recent studies, we can talk about a decrease in the incidence of HIV infection among children, thanks to competent diagnosis and treatment. Parents of HIV-infected children should be aware of modern methods of treating infection in order to make life easier and their adaptation in society.

HIV by its origin is a retrovirus in which the gene material consists of RNA. This type of virus is able, as a result of transformations, to penetrate the DNA of the body and destroy healthy cells or transform them into cancerous ones.

In the case of HIV, it destroys the immune defenses. It is difficult for such children to fight various kinds of infections. Therefore, parents should help their child organize life with HIV in such a way as to minimize the risk of complications.

Causes of HIV infection in children

In many countries, children who have been living with HIV for some time are under special medical supervision. The causes of the onset and transmission of the infection are still being studied.

Several of the main reasons are:

early and unprotected sexual contacts during adolescence with HIV carriers;
drug addiction, when a shared syringe is used to inject drugs;
in newborns, HIV infection enters the body during passage through the birth canal of an infected mother or during intrauterine development through the placenta;
blood transfusion from a donor - a carrier of infection - to a healthy child;
the use of poorly processed and disinfected medical instruments;
organ transplant from an infected donor.

The sites of localization of the immunodeficiency virus are the bloodstream, semen, vaginal discharge and cerebrospinal fluid. Infection from mother to child is considered the most common way (statistics show more than 80% of such cases).

Periods of infection in early childhood

With vertical transmission of the virus, three periods of possible infection are noted.

Perinatal

This is intrauterine transmission of the virus through the placental circulation. This period accounts for 20% of cases of all possible routes of transmission from the mother.

Intranatal

This is the name given to the transmission of infection when the skin of the newborn interacts with the vaginal secretions of the mother during natural childbirth. The risk of developing HIV in this period is the highest; it accounts for 60% of cases.

Postnatal

This is the transmission of the virus through mother's milk during breastfeeding. This stage accounts for about 20% of cases.

Doctors try to timely diagnose the disease in a future mother in order to prevent the possibility of natural childbirth and minimize the degree of danger to the newborn.

Factors that increase the risk of infection in children

The factors provoking the development of HIV are:

late detection of infection in a woman during pregnancy and the lack of preventive measures;
multiple pregnancy;
premature birth;
natural delivery;
uterine bleeding during pregnancy and childbirth;
mother's blood entering the baby's respiratory tract during birth;
drug and alcohol addiction of a pregnant woman;
breastfeeding by an HIV-infected mother;
the presence of various chronic diseases in the mother-carrier of the virus;
infection with different types of virus.

The manifestation of the disease in children differs from that of HIV-infected adults. Pediatricians consider one of the first manifestations of the immunodeficiency virus to be the pathology of the central nervous system.

Symptoms

When infected with a virus through the genital tract, an acute retroviral syndrome is observed. Then the disease goes through several stages: the first two are hidden, without pronounced symptoms, and in the next two stages, signs of infection in children already appear. Symptoms of vertical infection in the acute and latent period may not be observed.

In a third of infected children, after the incubation period, the first signs are noted in the form of various infections of the upper respiratory tract, skin rashes, meningeal symptoms and other childhood diseases. The duration of this stage varies from several days to two months.

The next four stages of HIV development proceed in different ways.

Asymptomatic manifestation

There is no clear course of the disease, but there may be an increase in 2 groups of lymph nodes. The duration of this stage is from two to ten years.

Second phase

A sharp decrease in weight is characteristic, defects appear on the skin and mucous membranes, as well as herpes zoster. During this period, the general state of health does not change.

Third stage

Immunodeficiency begins to appear in the body. The general condition is disturbed, causeless diarrhea occurs, there is a sharp loss of body weight, persistent fever, headache, increased sweating, memory loss and other signs. For HIV infection in children, the appearance of neurological disorders, oral candidiasis, CMV parotitis is also characteristic.

The fourth stage (actual stage of AIDS)

The body is already exhausted, severe signs of the disease appear, including tumor formations.

For young children affected by the virus, the presence of frequent bacterial infections is characteristic. In half of the cases, children suffer from inflammation of the middle ear, meningitis, dermatitis, pneumonia, sepsis, and damage to the musculoskeletal system. To alleviate their condition, it is important to diagnose the disease in time and start treatment.

Diagnostics

To diagnose HIV in children, a comprehensive study is used - the so-called analysis for the immune status. One of the necessary examinations is to determine the amount of antibodies to HIV. It is carried out using ELISA. If it is positive, an immune blotting test is prescribed, which is considered a reliable method for detecting the virus.

With a negative result, PCR helps to identify the disease, which has been used since 2 months of life.

Diagnosis includes other tests that detect abnormalities in the atypical course of the disease (including the MRI method with a contrast agent, which helps to determine the presence of the virus at the asymptomatic stage).

Treatment

Children born with HIV infection should be systematically monitored by specialists from the AIDS Center, pediatricians from the district clinic, and a phthisiatrician. At each appointment, doctors examine a small patient and assess his general condition, as well as conduct a series of studies, the results of which are used to judge the degree of damage to the immune system.

In addition, doctors evaluate the weight and height of infected children every six months, watch the Mantoux reaction, and take blood and urine samples. Parents make sure that the diet of an HIV-infected person is high in calories.

Principles of treatment therapy for HIV-infected children

HIV infection in children is not completely curable, so no medicine can destroy the virus, but it is quite possible to help the patient live fully with this problem. To do this, they are guided by the following principles:

Antiretroviral therapy, which is considered the mainstay of treatment for HIV infection in children. Along with this method, symptomatic treatment of secondary diseases caused by weakened immunity may also be required.
Any method of therapy can be used only after the parents of the child sign a consent to its use.
All necessary medicines are issued at the AIDS center at the place of residence of the HIV-infected patient; here, experts give recommendations on their use.
To reduce the level of resistance of the virus to certain drugs and increase the effectiveness of treatment, several different antiviral agents are prescribed.
Violation of the conditions for taking medications leads to a lack of treatment results, so it is important to strictly follow the instructions for taking medications.
The patient undergoes all stages of treatment at home under the supervision of doctors (in exceptional cases, hospitalization is required).

Therapeutic measures for HIV infection

Treatment, regardless of the route of entry of HIV infection into the child's body, should be started as early as possible. In addition to taking antiviral drugs, surgery may also be required (for example, if a tumor is detected).

One of the common methods of treatment is immunoreplacement therapy, when a patient receives a transfusion of a lymphocytic mass. In special cases, a bone marrow transplant is recommended. Often used immunomodulators that affect viral enzymes.

The effectiveness of treatment with these drugs is possible only with their regular use. Any interruption of medication is strictly prohibited. In order to avoid resistance of the virus to certain components, doctors periodically adjust the regimen for the use of drugs.

Depending on concomitant diseases, additional antibiotics, antifungal drugs, and also anti-tuberculosis are used.

We should not forget about taking vitamin complexes so that the adaptation of HIV-infected children in society is as complete as possible.

It is important to start treatment of the newborn immediately after birth if the mother did not receive any supportive therapy during pregnancy. First of all, breastfeeding is prohibited as one of the main ways of transmitting the virus.

Scientists around the world are conducting research on the invention of a drug that can deactivate HIV.

Forecast

The prognosis for children with HIV is quite serious. Parents of young patients are always interested in how long children with HIV live, and whether it is possible to cure HIV. Properly selected antiretroviral therapy significantly slows down the rate of development of the disease. Today, unfortunately, the disease is incurable, but if all the recommendations of doctors, including the treatment regimen, are followed, it is possible to achieve high-quality adaptation of infected children in society.

Prevention of HIV infection in children

An important role in reducing the incidence is played by the prevention of HIV infection in children, which includes a whole range of measures.

Primary prevention

This includes testing donated blood for the presence of a retrovirus. This will help to avoid infection when transfusing blood components to children when necessary. This group also includes the complete sterility of medical instruments intended for surgical manipulations, and strict control during organ transplantation in children.

Promotion of healthy lifestyles

This is especially important for preventing HIV infection among adolescents who have an early sex life or who use drugs. Awareness-raising activities should be carried out in schools, explaining the need to use condoms during sexual intercourse and the principle of legibility in intimate relationships. Psychologists, teachers, doctors and parents of teenagers are involved in such events. Society should try to instill in children a love of sports, family values, and responsibility for their own health and the health of their loved ones.

Perinatal prophylaxis

This is a set of measures taken when an immunodeficiency virus is detected in a pregnant woman. In such cases, it is recommended to terminate the pregnancy in the first trimester, and at a later date, strictly follow all the doctor's recommendations and adhere to the treatment regimen. These measures help reduce the risk of having sick children by half. Infected women should only give birth by caesarean section. After giving birth, the baby is forbidden to breastfeed. If the father is infected, only artificial insemination of the mother is possible.

Surveillance and vaccination of HIV-infected children

If there is an HIV-infected child in the family, it is necessary to register him in a medical institution in order to competently carry out therapeutic measures. It is strictly forbidden to hide this diagnosis from doctors; this can harm the child, depriving him of the opportunity to fully live. Timely vaccination of HIV-positive children is one of the important preventive measures.

Carefully following all the recommendations of doctors, delicately explaining to HIV-infected children the peculiarities of their lifestyle, it is possible to significantly improve the prognosis for young patients. The disease, although incurable today, but the work of many scientists gives positive results in this direction. Perhaps in the coming years, every HIV patient will get a chance for a long and happy life.

Clinical manifestations of childhood AIDS include defects in cellular immunity, the presence of one of the specific diseases that manifests HIV infection, manifestations of bacterial infections lasting more than 2 years, encephalopathy, and wasting syndrome.

AIDS syndromes in children

congenital dysmorphic syndrome (developmental disorders of organs and systems)
clinical manifestations of bacterial infections that occur with a high frequency
clinical manifestations of opportunistic infections, which occur with a much lower frequency
malignant tumors are rare

The frequency of clinical symptoms of AIDS in children and adults differ.

Frequency of AIDS symptoms in sick children and adults
Diseases and symptoms		In adults
Central nervous system damage, encephalopathy	cells of the nervous system are affected by HIV very often	lesions of the nervous system associated with the action of opportunistic infections, often manifested
Recurrent bacterial infections: Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Salmonella, E. coli	appear very often, have a long course (more than 2 years)	are rare, the frequency is 1% of all clinical symptoms
Congenital Desyndrome	manifests itself very often with intrauterine HIV infection	missing
Acute and chronic parotitis		rarely
Cardiopathies, nephro-, thrombocytopathies		rarely
Pneumocystis	Often	less than in children
Lymphocytic pneumonia	Often	rare, only 1% of all manifestations
Hypoalgammaglobuminemia in premature infants weakened by frequent infections, children with encephalopathies	rarely	missing
Hypergammaglobulinemia	occurs in 50% of children with AIDS AIDS	in almost 100% of cases
The emergence of opportunistic infections	only during the period of advanced AIDS	appear from the very beginning of the disease
Lymphoma of the brain		Often
Hepatitis B
Kaposi's sarcoma	rarely	Often

Clinical symptoms in children infected parenterally - through the blood, appear very early and have a severe course.

In the case of vertical infection of the fetus - from mother to fetus - the incubation period of HIV is up to 12 months. Parenteral infection of children is characterized by a longer incubation period of up to 41 months. However, after children become infected with HIV through blood transfusion, the incubation period can be very short - from 2 to 4 weeks.

First symptoms

fever that lasts 2-3 weeks
(more than 2 groups)
manifestations of angina, which resembles a mononucleosis complex
excessive sweating
, fatigue
measles rash on the skin
in peripheral blood - leukopenia, which lasts 2-4 weeks

After the first clinical manifestations, a long (sometimes tens of years) latent period of HIV infection begins. Some children do not have a period of first clinical manifestations, and the latent period of HIV stretches for 5-10 years. According to the new classification of HIV infection in children, this is stage P1 - the stage of the erased course of HIV.

Stage P1 HIV/AIDS

Stage P1 HIV/AIDS is characterized by the following symptoms:

polyadenopathy - the lymph nodes are painful, mobile, not soldered to the subcutaneous tissue
subfebrile condition - body temperature up to 38?
sweating
weakness, fatigue
children do not gain weight

This stage is called chronic lymphadenopathy. It has not yet been established what are the criteria for the transition of the stage of chronic lymphadenopathy to the next stage of HIV / AIDS - preAIDS or stage P2 - the stage of a clinically pronounced infection, namely, to the stage P2a - the stage of non-specific signs.

Stage P2a HIV/AIDS

Manifestations of stage P2a of HIV / AIDS in children:

persistently elevated body temperature
lymphadenopathy
sweating, especially at night
and weight loss
recurrent nasopharyngitis, bronchitis, otitis, bacterial and viral etiology
herpetic rash on the skin, fungal lesions, pustular elements
candidal stomatitis, esophagitis
mumps
hepato-and splenomegaly
violation of the physical development of the child

The clinic of advanced AIDS in children is manifested by various symptom complexes of progressive diseases, depending on the age of the child.

In newborns infected with HIV, lesions of the central nervous system begin to appear from 2 months to 5 years. NeuroAIDS is determined in 50-80% of cases. Damage to the nervous system in children with HIV is primary, due to the reproduction of the virus and the expression of the virus genome in the brain cells themselves. The AIDS virus is found in cerebrospinal fluid, biopsies of the brain and spinal cord. Secondary infections of the central nervous system with HIV in children are very rare (in 10% of cases).

Stage P2b HIV/AIDS in children

Stage P2b HIV/AIDS in children is characterized by progressive neurological diseases:

chronic meningitis
attacks
subacute encephalopathy
progressive dementia

Progressive encephalopathy in children ends in death after 12-16 months.

In the 1st year of life, HIV-infected children show the following symptoms from the nervous system:

hypertonicity, tremor of the limbs, twitching of small muscles, general convulsions; ataxia
para-and tetraparesis
pathological reflexes
pseudobulbar paralysis
extrapyramidal rigidity
mental retardation
microcephaly

Diagnosis of HIV/AIDS in children is based on clinical manifestations. Brain lesions confirm, in which atrophy of the cerebral cortex is determined, an increase in the ventricles of the brain. Only HIV-infected children are characterized by calcifications of the basal ganglia of both cerebral hemispheres. On autopsy of brain tissue in HIV, a decrease in brain mass, perivascular infiltrates containing multinuclear ganglion cells, disappearance of myelin, calcification of blood vessels, and white matter astrocytosis are determined. Anti-HIV antibodies are found in the cerebrospinal fluid.

In the 1st year of life in HIV-infected children, pneumocystis pneumonia can occur in 75% of cases, in children older than 1 year - in 38% of cases. More often, pneumocystis pneumonia develops at the 5-6th month of a child's life and has the following clinical manifestations:

dry persistent cough
high body temperature
tachypnea - rapid breathing
sweating, especially at night
progressive weakness
auscultatory lung crepitus and small bubbling wet rales
percussion - dullness of sound over the lungs
the course of pneumocystis pneumonia is recurrent or protracted

The diagnosis of pneumocystis pneumonia in HIV-positive children is confirmed by x-ray studies. On the radiograph, diffuse infiltration of the lung fields, increased lung pattern are determined. Pneumocysts are determined in the biological material.

Stage P2c HIV/AIDS

Stage P2c HIV/AIDS in children presents with lymphocytic interstitial pneumonia, which is unique to childhood AIDS and is not associated with additional infection. Histologically, diffuse infiltration of alveolar septa and peribronchial areas with lymphocytes and immunoblasts is determined. Clinical manifestations of interstitial pneumonia differ from pneumocystis pneumonia, namely:

the onset of the disease is imperceptible, progresses slowly
dry cough, shortness of breath
dry mucous membranes
rapid development of symptoms of chronic respiratory failure
development of respiratory destress syndrome with hypoxia.

The diagnosis is based on clinical manifestations and is confirmed radiologically. On x-ray images, diffuse infiltration of the lung fields, mediastinal lymphadenopathy are determined.

Stage P2dHIV/AIDS

Stage P2dHIV/AIDS in children is manifested by recurrent bacterial infections, which give the following manifestations:

purulent otitis media
meningitis
purulent pneumonia with abscess
bacterial sepsis
osteomyelitis
pneumonia caused by avian tuberculosis bacillus
mumps

Unlike adults, AIDS-related and opportunistic infections are rare in children.

HIV/AIDS stage P2e

The stage of HIV/AIDS P2eu in children is manifested by secondary tumors, brain lymphoma. One third of HIV-infected adults have Kaposi's sarcoma.

In children, Kaposi's sarcoma is very rare, but its course is very malignant and has the following features:

foci of sarcoma with a warty surface
color dark brown or bluish red
the lesion is determined on the head, on the mucous membrane of the oral cavity, stomach (in adults, the limbs are affected first)

Primary brain lymphoma in children with HIV/AIDS is very rare.

Stage P2f HIV/AIDS

AIDS stage P2f is characterized by manifestations of organ diseases, namely:

nephropathy
cardiopathy
thrombocytopathy - impaired function
multiple arteriopathy
hepatopathy.

Organ pathology in AIDS in children is manifested by the following symptoms:

hypertension and dilatation of the heart,
coronary thrombosis
nephrotic syndrome
kidney failure

In children infected with HIV in utero in early pregnancy, manifestations of clinically pronounced AIDS are observed at 4-6 months, the final diagnosis is made at 9 months. During this period of life of children with AIDS, high mortality is determined. In such children, the main symptoms are dysmorphic syndrome (HIV embryopathy), which has the following manifestations:

microcephaly
absence of nasal membranes
growth retardation
increasing the distance between the eyes
flattened forehead
triangular groove of the upper lip protrudes forward
blue cornea of the eye
strabismus, exophthalmos
upper lip rupture

The cause of death in children with AIDS at an early age is pneumocystis pneumonia or bacterial sepsis.

The assessment of the condition of children with manifestations of childhood HIV/AIDS is based on an epidemiological history and clinical symptoms. Throughout the world, childhood AIDS is called familial. Therefore, for the diagnosis of pediatric AIDS, it is necessary to examine HIV-positive pregnant women.

Symptoms of HIV/AIDS in children was last modified: November 26th, 2017 by Maria Bodyan

Early clinical signs of HIV in children. Symptoms of HIV infection in children of different ages. Video - HIV Symptoms

Causes

Pathogenesis

Video - HIV Symptoms

Diagnostics

Treatment

Prevention measures

Why HIV develops

How does infection occur in newborns?

First signs and later

Stages of the disease

Diagnostics

Treatment

Why HIV develops

How does infection occur in newborns?

First signs and later

Stages of the disease

Diagnostics

Treatment

Causes of HIV infection in children

Periods of infection in early childhood

Perinatal

Intranatal

Postnatal

Factors that increase the risk of infection in children

Symptoms

Asymptomatic manifestation

Second phase

Third stage

The fourth stage (actual stage of AIDS)

Diagnostics

Treatment

Principles of treatment therapy for HIV-infected children

Therapeutic measures for HIV infection

Forecast

Prevention of HIV infection in children

Primary prevention

Promotion of healthy lifestyles

Perinatal prophylaxis

Surveillance and vaccination of HIV-infected children

AIDS syndromes in children

Frequency of AIDS symptoms in sick children and adults

First symptoms

Stage P1 HIV/AIDS

Stage P2a HIV/AIDS

Stage P2b HIV/AIDS in children

Stage P2c HIV/AIDS

Stage P2dHIV/AIDS

HIV/AIDS stage P2e

Stage P2f HIV/AIDS