MEDICAL MANAGEMENT OF HIV DISEASE IN CHILDREN

Pediatric HIV infection in the United States has evolved from a rapidly progressive, fatal disease in the early years of the epidemic to a chronic infection with prolonged survival. Many children with perinatally acquired infection survive to 8 years of age and older. The development of highly active antiretroviral therapy (HAART), measurement of viral load, and availability of prophylactic medications to prevent certain opportunistic infections have dramatically altered the management of HIV infection. A total of 14 antiretroviral agents have been approved by the US Food and Drug Administration, 10 of which have been approved for use in pediatrics. Several new drugs are in various stages of development. This article discusses special issues in the medical management of children with HIV infection, including routine care, immunization, and treatment of some of the more common organ-specific manifestations, disclosure of the HIV diagnosis, pain management, palliative care, and the management of infants born to HIV-seropositive women.