Although HIV infection is believed to eventually have a fatal outcome, much can still be done to improve the quality and length of these children’s lives.
Because young children, especially those born pre-term, have an immature immune system, the course of the disease is more rapid than in adults.
The earlier the onset of symptomatic HIV infection, the poorer the expected outcome. Infants who are infected before delivery probably present early while infants infected via breast milk probably present late.
The clinical categories and immunological status (CD4 percentage) can be used to give an idea of the expected outcome. Children with asymptomatic HIV infection and an intact immune system (normal CD4 percentage) do best while the children with stage 3 or 4 HIV infection and a damaged immune system have the worst outlook.
Children with AIDS who do not receive antiretroviral therapy die much sooner than those who receive full treatment.
The progress in HIV-infected children can be roughly divided into 3 groups:
- About a third of children present with clinical signs of HIV infection within the first year of life. Without antiretroviral therapy they have a rapid progression of their disease and usually die before 2 years of age (‘fast progressors’).
- Another third of children present later, between the ages of 1 and 5 years. Their disease runs a slower course.
- The remaining third present after the age of 5 (‘low progressors’). They have the best outlook and may live for 10 years or more (similar to adults) even without antiretroviral therapy.
Children with an early onset of symptomatic HIV infection have the worst outcome.