New Scarlet Letter(s), Pediatric AIDS

¹ The Departments of Pediatrics, University of Southern California School of Medicine, Children's Hospital of Los Angeles, and University of California, Los Angeles, School of Medicine, Los Angeles, and the AIDS Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta

Acquired immune deficiency syndrome (AIDS) is a new (since 1981) and devasting epidemic disorder of extraordinary morbidity and mortality. As many as 1 million individuals in the United States may be infected with the virus, and 1% of these have the full-blown disease. Although AIDS was initially believed to affect only male homosexuals, other populations found to be at risk are intravenous drug abusers, female sexual partners of patients with AIDS or carriers, multi-infused hemophiliacs, other recipients of blood products, and children born to infected mothers. Of critical importance to the pediatrician is the fact that AIDS occurs in children, making up about 1.5% of the total cases reported. Some of these children are of school age and have minimal or no symptoms. They are, despite the recommendations of the US Centers for Disease Control (CDC), being excluded from school and society, with all of the psychologic implications that befell Hester Prynne, Nathaniel Hawthorne's adulteress.

DEFINITION

The CDC defines pediatric AIDS as a reliably diagnosed disease at least moderately indicative of underlying cellular immune deficiency with exclusion of other causes of cellular immune deficiency. As in adult AIDS, opportunistic infections (eg, Pneumocystis) or unusual malignancies (eg, Kaposi's) may occur in these children. Furthermore, an antibody test for human lymphotropic virus type III (HTLV-III) should be positive. Primary immunodeficiencies (eg, severe combined immune deficiency, combined immune deficiency with immunoglobulins [Nezelof's syndrome], DiGeorge syndrome, etc) and secondary immunodeficiencies (eg, immunosuppressive therapy, lymphoreticular malignancy, congenital infection, malnutrition, etc) should be excluded. The CDC has recently added histologically documented lymphoid interstitial pneumonitis (with a positive HTLV-III test) in a patient less than 13 years of age as one of the acceptable criteria for the diagnosis of pediatric AIDS.

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