HIV through the Life Cycle
HIV infection can occur at any time in the life cycle from the newborn period, through childhood and adolescence to adulthood, older age. The unique issues and special vulnerabilities involved with each aspect of the life cycle, from family planning to pregnancy and the newborn to older aged person with HIV, are addressed from the biopsychosocial standpoint. While some features of HIV illness are common to any age group, specific challenges arise at various stages of the life cycle, as well as different patterns of transmission, clinical course, and service needs. This chapter will consider such differences at various stages of the life cycle. At the beginning of the AIDS epidemic almost 30 years ago, infected blood products represented a common mode of transmission, with many children diagnosed with HIV infection after receiving transfusions for hemophilia and blood disorders. Because of current practices of screening blood products prior to transfusion, the face of neonatal and early-childhood HIV has changed considerably, to one of children who are infected mostly perinatally through vertical transmission, rather than through exposure to blood products. While the incidence of perinatally acquired infections is decreasing in areas of the world where there is access to HIV care and antiretroviral medication, some transmission of HIV from mother to child remains, both in the United States and throughout the world. In 2007, approximately 79 infants were born with HIV in the United States, compared with 330 in 1994 (CDC, 2007). The primary means of HIV infection of a newborn is vertical transmission during gestation, birth, or breastfeeding of an infant by an HIV-positive mother. It is strongly recommended that all pregnant women be screened for HIV infection as part of routine prenatal care. Such screening is not legally mandatory, however, and may not be performed without the mother’s consent. It is advantageous to obtain HIV testing as early as possible in the course of a pregnancy so that preparation can be made to reduce the risk of transmission to the infant. Without preventive care during gestation or delivery, the risk of transmission from mother to child is 15%–35% (Newell, 1991; Gabiano et al., 1992).