Christiansen C B, Heilmann C J
Statens Seruminstitut, virologisk afdeling, København.
Ugeskr Laeger. 1994 Apr 25;156(17):2568-70, 2573-5.
More children will be born infected with HIV in the years to come. Children with early symptoms will come into quick contact with a hospital, while others may be infected for up to ten years without presenting HIV-related symptoms. HIV infection can be diagnosed early with a combination of methods that are currently available (viral culture, ELISA antigen testing), and also with methods that are at present only used in research (DNA and RNA detection with PCR). Together with the clinical picture, it should be possible to have a reliable diagnosis no later than six months after birth. The general development of the children can be followed at frequent out-patient visits, while prophylactic measures can quickly be put into motion when necessary. The course of the illness can be followed and predicted with the help of different laboratory investigations. The medical treatment of HIV positive children follows the pattern of adult HIV positive patients. Children with an increased risk of bacterial infections can receive intravenous immune globulin as prophylaxis. HIV infected children can be given the common vaccinations, but BCG and oral anti-polio vaccine should not be given to children with symptomatic HIV infection. Prophylaxis of vertical transmission of HIV should be aimed at HIV testing of all pregnant women, to prevent this route of transmission. As long as there is no efficient treatment of HIV infection, termination of pregnancy must be recommended early after conception to all HIV positive women. Children born of HIV positive mothers should not be breast-fed.
在未来几年,将会有更多儿童出生时感染艾滋病毒。出现早期症状的儿童会很快前往医院就诊,而其他儿童可能在长达十年的时间里受到感染却没有出现与艾滋病毒相关的症状。目前可用的多种方法(病毒培养、酶联免疫吸附测定抗原检测)以及目前仅用于研究的方法(通过聚合酶链反应进行DNA和RNA检测)相结合,能够早期诊断艾滋病毒感染。结合临床表现,应该有可能在出生后六个月内做出可靠诊断。可以通过频繁的门诊随访来跟踪儿童的一般发育情况,必要时可迅速采取预防措施。借助不同的实验室检查能够跟踪和预测疾病进程。艾滋病毒呈阳性儿童的医疗遵循成年艾滋病毒呈阳性患者的模式。有细菌感染风险增加的儿童可接受静脉注射免疫球蛋白作为预防措施。艾滋病毒感染儿童可以接种常规疫苗,但有症状的艾滋病毒感染儿童不应接种卡介苗和口服脊髓灰质炎疫苗。预防艾滋病毒的垂直传播应针对所有孕妇进行艾滋病毒检测,以防止这种传播途径。只要没有有效的艾滋病毒感染治疗方法,就必须建议所有艾滋病毒呈阳性的妇女在受孕后尽早终止妊娠。艾滋病毒呈阳性母亲所生的儿童不应母乳喂养。