Psychiatric issues in pediatric HIV/AIDS

Introduction Human immunodeficiency virus (HIV) transmission now occurs at a higher rate among women and youth than other groups. Worldwide, about 2.7 million children under age 15 and more than 10 million aged 15–24 are afflicted, and half of all new infections occur among young people (UNAIDS, 2001). In the USA, for example, there are at least three HIV-seropositive youths for every known case of adolescent AIDS, and the number of reported pediatric HIV cases more than doubled from 2000 to 2001 (Centers for Disease Control and Prevention, 2001). More than 90% of pediatric infections occur through vertical (mother-to-child) transmission. Most adolescents (ages 13–24) who become infected acquire HIV through sexual transmission, followed by injection drug use (Centers for Disease Control and Prevention, 2001). Despite improvements in antiretroviral therapies, child mortality due to AIDS remains significant. As of 2000, more than 4.3 million children under 15 had died of AIDS, and more than 13 million had lost their mothers or both parents to AIDS (UNAIDS, 2000). Fortunately, recent developments in antiretroviral therapy have helped decrease the incidence of vertical transmission, and reduce the treatment burden on those infected, more than doubling their life expectancy. More children with HIV are living past 10–15 years of age. Even without medical treatment, many HIV-infected children may remain asymptomatic for as long as a decade.