Role of the General Pediatrician in the Management of Human Immunodeficiency Virus Infection in Children
Thomas H. Rand MD, PhD1
Alan Meyers MD, MPH2
1 Clinical Assistant Professor, Department of Pediatrics and WAMI Medical Education Program, University of Washington, Seattle, WA.
2 Assistant Professor, Department of Pediatrics, Boston University School of Medicine and Boston City Hospital, MA.
Human immunodeficiency virus (HIV) infection is a chronic progressive disease affecting an estimated 20 000 children in the United States. Management of this infection and its complications is evolving rapidly and requires the coordinated services of a number of disciplines, which may be facilitated by centers having programs in pediatric HIV infection. However, much of the care for an HIV-infected child can be supervised by a primary care physician, particularly during the early phase of infection, when anticipatory health monitoring is emphasized. Many pediatricians have had no experience with HIV infection during residency training, and those who have may have cared only for inpatients who had advanced immunodeficiency. The trend in medical care for HIV infection is toward early detection and management, as in other chronic diseases of childhood. This review summarizes those aspects of HIV infection most likely to be encountered in general pediatric practice.
There are several distinct problems in the delivery of care for infants and children who are infected with HIV:
1) At this time, HIV infection is a progressive, ultimately fatal disease. Interventions are directed at preserving function and quality of life.
2) HIV is an infectious disease. Preventing transmission should be addressed at every opportunity, both to point out activities having potential for transmission and to reassure families of the safety of other types of contact.
