Treatment for HIV has come a long way in recent years. Today, many children living with HIV thrive into adulthood.

HIV is a virus that attacks the immune system. That makes children with HIV more vulnerable to infection and disease. The right treatment can help prevent illness and keep HIV from progressing to AIDS.

Read on as we discuss causes of HIV in children and the unique challenges of treating children and adolescents living with HIV.

Vertical transmission

A child can be born with HIV or contract it soon after birth. HIV contracted in utero is called perinatal transmission or vertical transmission.

HIV transmission to children can happen:

Of course, not everyone who has HIV will pass it to their baby, especially when following antiretroviral therapy.

Worldwide, the rate of transmitting HIV during pregnancy falls to below 5 percent with intervention, according to the World Health Organization (WHO). Without intervention, the rate of transmitting HIV during pregnancy is about 15 to 45 percent.

In the United States, vertical transmission is the most common way children under age 13 contract HIV.

Horizontal transmission

Secondary transmission, or horizontal transmission, is when HIV is transferred by contact with infected semen, vaginal fluid, or blood.

Sexual transmission is the most common way teens contract HIV. Transmission can occur during unprotected vaginal, oral, or anal sex.

Adolescents may not always use a barrier method of birth control, or use it correctly. They may not know they have HIV and pass it to others.

Not using a barrier method like a condom, or incorrectly using one, can raise the risk of getting a sexually transmitted infection (STI), which also increases the risk of contracting or transmitting HIV.

Children and teens who share needles, syringes, and similar items are also at risk for contracting HIV.

HIV can be transmitted through infected blood in healthcare settings, too. This is more likely to occur in some regions of the world more than others. According to the Centers for Disease Control and Prevention, it’s extremely rare in the United States.

HIV doesn’t spread through:

  • insect bites
  • saliva
  • sweat
  • tears
  • hugs

You can’t get it from sharing:

  • towels or bedding
  • drinking glasses or eating utensils
  • toilet seats or swimming pools

An infant may not have any obvious symptoms at first. As the immune system weakens, you may start to notice:

  • lack of energy
  • delayed growth and development
  • persistent fever, sweating
  • frequent diarrhea
  • enlarged lymph nodes
  • repeated or prolonged infections that don’t respond well to treatment
  • weight loss
  • failure to thrive

Symptoms vary from child to child and with age. Children and teens may have:

Children with untreated HIV are more vulnerable to developing conditions such as:

HIV is diagnosed through blood testing, but it may take more than one test.

The diagnosis can be confirmed if the blood contains HIV antibodies. But early on in the course of infection, antibody levels may not be high enough for detection.

If the test is negative but HIV is suspected, the test can be repeated in 3 months and again at 6 months.

When a teenager tests positive for HIV, all sexual partners and people they may have shared needles or syringes with must be notified so they can also be tested and start treatment, if needed.

In 2018, the CDC reported new HIV cases in the United States by age as:

AgeNumber of cases
0–13 99
13–14 25
15–19 1,711

HIV may not have a current cure, but it can be effectively treated and managed. Today, many children and adults with HIV live long, healthy lives.

The main treatment for children is the same as adults: antiretroviral therapy. Antiretroviral therapy and medications help prevent HIV progression and transmission.

Treatment for children requires a few special considerations. Age, growth, and stage of development all matter and have to be reassessed as the child progresses through puberty and into adulthood.

Other factors to take into account include:

  • severity of HIV infection
  • the risk of progression
  • previous and current HIV-related illnesses
  • short- and long-term toxicities
  • side effects
  • drug interactions

A 2014 systematic review found that starting antiretroviral therapy soon after birth increases an infant’s life span, decreases serious illness, and decreases the chances of HIV progressing to AIDS.

Antiretroviral therapy involves a combination of at least three different antiretroviral drugs.

When choosing which drugs to use, healthcare providers consider the possibility of drug resistance, which will affect future treatment options. Medications may have to be adjusted from time to time.

One key ingredient for successful antiretroviral therapy is adherence to the treatment regimen. According to the WHO, it takes adherence of more than 95 percent for sustained suppression of the virus.

Adherence means taking the medications exactly as prescribed. This may be difficult for children, especially if they have trouble swallowing pills or want to avoid unpleasant side effects. To remedy this, some medications are available in liquids or syrups to make it easier for young children to take.

Parents and caregivers also need to work closely with healthcare providers. In some cases, family counseling may be beneficial for everyone involved.

Adolescents living with HIV may also need:

  • mental health counseling and support groups
  • reproductive health counseling, including contraception, healthy sex habits, and pregnancy
  • testing for STIs
  • substance use screening
  • support for a smooth transition into adult healthcare

Research into pediatric HIV is ongoing. Treatment guidelines may be frequently updated.

Be sure to keep your child’s healthcare provider informed of new or changing symptoms, as well as medication side effects. Never hesitate to ask questions about your child’s health and treatment.

Although clinical trials are underway, there are currently no approved vaccines to prevent or treat HIV.

But because HIV can make it harder for your body to fight infections, children and teens with HIV should be vaccinated against other diseases.

Live vaccines can trigger an immune response, so when available, people with HIV should get inactivated vaccines.

Your healthcare provider can advise you on the timing and other specifics of vaccines. These may include:

When traveling outside the country, other vaccines, such as those that protect against cholera or yellow fever, may be advisable, too. Talk to your child’s doctor well before international travel.

Growing up with HIV can present many challenges for children and parents, but adhering to antiretroviral therapy — and having a strong support system — can help children and adolescents live healthy, fulfilling lives.

There are many support services available for kids, their families, and caregivers. For more information, ask your child’s healthcare providers to refer you to groups in your area, or you can call your state’s HIV/AIDS Hotline.