Pediatric HIV and AIDS
Rachel G. English
Bon Secours Memorial College of Nursing

I have neither given nor received aid, other than acknowledged, on this assignment, nor have I
seen anyone else do so.
~ Rachel Goins English



Pathophysiology of HIV and AIDS
HIV is an ongoing and incurable virus that violently takes over the body. When HIV
progresses and goes untreated, Acquired Immunodeficiency Syndrome (AIDS) develops.
According to Avert, an international HIV and AIDS charitable organization, there are 3.2 million
children living with HIV around the world and every day 700 children are added to that total
(Children, HIV and AIDS, 2014).
HIV may be transmitted via contact with infected blood or body fluids (Pegues & Schub,
2015). This is seen in unsafe intercourse or the use of unclean needles in adolescents and adults.
The most common form of transmission in young children is by vertical transmission, or motherto-child. It would come from a HIV positive mother either during pregnancy, delivery or
breastfeeding. The child will be highly susceptible to infections and may spread HIV to others
unknowingly. To inhibit this, patient (and parental) education is key to keeping these children
healthy (Durham, & Chapman, 2014).
Nursing Care for HIV and AIDS
In HIV, the virus attacks and kills T­helper cells. The T­helper cell is responsible for 
keeping the body’s immune system strong and fight off infection (HIV and AIDS, 2012). With 
the loss of T­helper cells, the child is at a much greater risk for complications such as 
pneumonia, candidiasis or, toxoplasmosis. It is important to monitor and assess the pediatric 
patient for signs and symptoms of infection (fever, cough, elevated white blood cells). Many 
ongoing symptoms from the HIV virus include extreme fatigue, weight loss and fever. The nurse
must inquire about when the symptoms began and how severe they have become. Proper
nutrition is essential for the child; the nurse can help to provide resources if necessary (Pegues
and Schub, 2015).



For a child diagnosed with HIV, there are some recommendations to follow in order to
stay well and prevent infection. The parent or caregiver must be taught to handle and store food
properly. The child must be careful not to ingest untreated water from swimming pools, lakes
and rivers. And the importance of hand hygiene must be stressed to the patient and caregiver in
order to prevent infection. Another point for teaching is to strictly follow the medication
prescription, taking medications exactly when ordered. Make sure the caregiver understands that
if the schedule is not followed, the child may become resistant and the drugs will become
ineffective (Matteucci and Caple, 2014). It is important for the child to receive adequate sleep,
plenty of protein, zinc and vitamin A. Protein will help boost their immune system and zinc and
vitamin A will aid in cell growth (Durham, & Chapman, 2014).
Hospital Policy for HIV
Bon Secours Health Systems has a policy in place for the expectant mother who is
unaware of her HIV status. The policy states that a rapid HIV test would be drawn to determine
her status. If it is found she is HIV positive, she will immediately begin antiretroviral (ARV)
prophylaxis in the hope to reduce the chance of her infant contracting the virus from her. The
infant will also be treated immediately following birth for up to six weeks, until follow up tests
show the infant is negative for HIV. Within the first hour of life, the infant must be bathed to
prevent the spread of infection especially before the infant is stuck with a needle. With this
hospital policy in place, the mother-to-child transmission of HIV has been cut in half (Rapid
HIV Testing for Mothers in Labor and Delivery, 2013).
Complications and Long-Term Consequences of HIV and AIDS
There is no cure for HIV or AIDS. Highly active antiretroviral therapy (HAART) is
available to slow the progression of the virus however it does not completely rid the body of the



virus. HIV puts the patient at a greater risk for opportunistic infections due to the diminished
immune system. Often times the parent, the child’s main system of support, has HIV or AIDS as
well. One complication a pediatric patient may face is a lack of health care and therefore no
access to the HAART medication. The medication therapy currently comes at a high cost and
many are not able to afford it. Due to the stigma around HIV and AIDS, a caregiver may not
want to know or may not disclose the HIV status of the child. The child may struggle with the
diagnosis or HIV or living with HIV, special care must go to the child’s mental and emotional
needs as well as their physical needs (Children, HIV and AIDS, 2014).
Primary, Secondary and, Tertiary Prevention of HIV and AIDS
In order to prevent the onset of HIV from ever occurring in a child, priority may be
placed on primary prevention by way of prenatal care and education to the mother. If the mother 
is receiving highly active antiretroviral therapy while she is pregnant and while she breast feeds, 
her baby will be protected from the virus. The mother needs education and access to health care 
to receive this therapy. It is also important for a child to remain up to date on his or her 
immunizations in order to abstain from contracting HIV (Kloser and Nakata, 2015).
Secondary prevention is put into practice when screening for the HIV virus. A form of 
secondary prevention is earlier recognition and treatment. After a HIV positive mother or high­
risk mother delivers an infant, the health care team must begin the screening process on the 
infant.  If the infant tests negative, the screening should be repeated at 1 to 2 months, 3 months, 6
months, 12 months and 18 months. This is because the infant may have the maternal antibodies 
masking the virus up to 18 months (Ball and Bindler, 2012, p. 653).  Another form of secondary
prevention is taking steps to prevent the spread to others. This can be done for children by using



formula instead of breastfeeding from a HIV positive mother (Pegues and Schub, 2015). The
child with HIV/AIDS must also be aware that they do not share bodily fluids with other children.
The goal of tertiary prevention in HIV/AIDS is to reduce the effects the virus has on the
body. Highly active antiretroviral therapy (HAART) includes at least three antiretroviral agents
to delay replication of HIV. By slowing the replication of the virus, the T-lymphocytes
summarize, by receiving HAART, the patient’s viral load (level of HIV in the blood) will
decrease which then reduces the risk of infection and transmission to others (HIV Testing, 2015).
Recommendation for Nursing Practice in HIV and AIDS
In the United States, care for the HIV child has seen significant improvements. With
education and encouragement to receive prenatal care and attend follow-up appointments,
children with HIV are taking their HAART medications and not transmitting HIV to others.
“The use of antiretroviral therapy decreases number of hospitalizations, improves quality of life,
and markedly enhances survival in children with HIV infection” (Matteucci and Caple, 2014).
One area that has not seen such improvement, 91% of children with HIV live in Sub-Saharan
Africa, where access to health care is almost nonexistent. Avert is encouraging health care
workers to lend a helping hand to this vulnerable population. These children not only need
HAART, but also emotional support, encouragement to their caregivers, help in school and the
protection of their human and legal rights (Lashley and Durham, 2010, p. 461-498).
All in all, factors that lead to the spread and harm of AIDS include the lack access to
education, being a part of a low socioeconomic class and lack of proper health care. With proper
education and support as well as the distribution of the antiretroviral therapy, health outcomes
may be improved.



Ball, J., & Bindler, R. (2012). Principles of pediatric nursing: Caring for children (5th 

ed., p. 

653). Boston, MA: Pearson Education, Inc.
Children, HIV and AIDS. (2014, July 30). Retrieved August 31, 2015, from­and­hiv­aids.htm
Durham, R., & Chapman, L. (2014). High­Risk Antepartum Nursing Care. In Maternal­newborn
nursing: The critical components of nursing care (Second ed., pp. 164­165). 
Philadelphia, PA: F.A. Davis Company.
HIV and AIDS. (2012, February 1). Retrieved August 30, 2015.
HIV Testing. (2015, June 30). Retrieved September 19, 2015, from
Kloser, P., & Nakata, K. (2015). What is Good Practice? HIV Care Beyond ART (11HC07). 
Retrieved August 28, 2015.
Lashley, F., & Durham, J. (2010). Children and HIV Prevention and Management. In The person
with HIV/AIDS: Nursing perspectives (4th ed., pp. 461­498). New York, New York: 
Springer Publishing Company.
Lawrewnce, P. (2015). HIV Infection/AIDS: Antiretroviral Therapy and Drug Resistance. 
Cinahl Information Systems. Retrieved August 26, 2015, from EBSCOhost.
Matteucci, R., & Caple, C. (2014). HIV Infections: Prevention of Opportunistic Infections in 
Infants and Children with HIV. Cinahl Information Systems. Retrieved August 26, 2015, 
from EBSCOhost.



Pegues, C., & Schub, T. (2015). Acquired Immunodeficiency Syndrome (AIDS). Cinahl 
Information Systems. Retrieved August 26, 2015, from EBSCOhost.
Rapid HIV Testing for Mothers in Labor and Delivery. (2013, March 1). Retrieved August 31,