Acquired Immune Deficiency Syndrome (AIDS), also known as acquired immuno deficiency syndrome, is caused by infection with the Human Immunodeficiency Virus (HIV). Since its discovery in 1981, the disease has primarily been prevalent in Europe, America, and Africa. In recent years, its incidence in China has shown an increasing trend year by year. Children often contract the disease through vertical transmission from infected mothers or due to repeated transfusions of HIV-contaminated blood products (such as in hemophilia patients), with a minority of cases resulting from the use of contaminated medical equipment.

is a retrovirus that primarily invades the human body by binding to the HIV receptor molecules (CD4+ molecules) on the surface of CD4+ T lymphocytes (it can also bind to mononuclear macrophages, brain glial cells, etc.). It then enters the cells to replicate and destroys the host cells, leading to a reduction in the number of CD4+ T lymphocytes and causing severe, irreversible cellular immune dysfunction. In children, the infection often also affects B lymphocytes, resulting in humoral immune disorders, which increase susceptibility to many opportunistic infections and can lead to the development of certain tumors. To date, there is still no effective treatment for this disease, and the mortality rate remains high, making prevention a critical priority.

bubble_chart Clinical Manifestations

Symptomatic HIV infection in vertically transmitted cases mostly manifests between 4 to 18 months after birth. Intrauterine infection can lead to small-for-gestational-age infants, while postnatal infection results in growth and developmental disorders. Symptomatic HIV infection presents in two clinical types.

1. AIDS-related complex (ARC): ARC refers to mild or atypical manifestations of Acquired Immune Deficiency Syndrome, commonly including generalized lymphadenopathy, hepatosplenomegaly, chronic diarrhea, cutaneous and mucosal candidiasis, recurrent upper respiratory infections, otitis media, and developmental delays. Serological tests show the presence of HIV antibodies.
2. AIDS symptoms:
   1. ARC symptoms are as above.
   2. Increased susceptibility to various infectious diseases, often with recurrent fever accompanied by viral, bacterial, or fungal infections. There are also recurrent mycobacterial and other opportunistic infections, commonly chronic interstitial pneumonia or Pneumocystis carinii pneumonia. The latter has a slow onset, prolonged course, fever, weak cough, difficulty expectorating sputum, and mild respiratory distress, ultimately leading to death from respiratory failure. Cytomegalovirus retinitis and other eye diseases are frequently observed.
   3. HIV encephalopathy: Caused by direct HIV infection, it is more common in infants and young children, presenting with intellectual and motor developmental delays, seizures, etc. Cerebrospinal fluid may be normal or show elevated lymphocytes and protein. HIV virus can be isolated, and HIV-specific core antigens can be detected. EEG may show mild to grade II abnormalities, while CT may reveal brain atrophy and basal ganglia calcification.
   4. Increased risk of lymphoma and Kaposi's sarcoma. The latter often presents as focal malignant tumors of the skin, mucosa, lymph nodes, and visceral blood vessels, appearing as pink or purplish nodules, patches, or plaques on the palms, soles, lower limbs, or entire body. Widespread Kaposi's sarcoma is a common cause of AIDS-related death.

bubble_chart Auxiliary Examination

1. Evidence of HIV infection
   1. Positive HIV antibodies p24 and gp120 indicate that the child has had or currently has HIV infection. The ELISA method for detecting HIV antibodies is a screening test. If the result is positive twice, it must be confirmed by the Western blot method. Since passive antibodies from the mother can persist for 15–18 months, a positive antibody test is meaningful only for children older than 18 months.
   2. A positive HIV virus isolation or detection of HIV DNA by PCR indicates current HIV infection. PCR testing is rapid, highly sensitive, and specific, making it particularly suitable for diagnosing perinatal infections in infants.
2. Immunological tests
   1. Polyclonal hypergammaglobulinemia, including elevated IgG, IgA, and IgD, often appears early. Specific antibodies are usually not produced after vaccination.
   2. Changes in cellular immune function: decreased total lymphocyte count, reduced absolute CD4+ T lymphocyte count, decreased or inverted CD4/CD8 ratio, impaired lymphocyte transformation test, and loss of delayed-type hypersensitivity skin test response.
   3. Increased circulating B-cell count.

bubble_chart Diagnosis

Diagnostic Criteria for Pediatric HIV Infection

1. Maternal antibody positive, child<15個月:
   1. HIV or related DNA detected in autologous blood or tissue.
   2. HIV antibody positive, decreased CD4+ lymphocyte count, and symptomatic infection present.
   3. Presence of AIDS clinical manifestations.
2. Maternal antibody positive, child >15 months:
   1. HIV or related DNA detected in autologous blood or tissue. LI>HIV antibody positive.
   2. Presence of AIDS clinical manifestations.

bubble_chart Treatment Measures

(1) Application of Anti-HIV Infection Drugs

AD

TCM can effectively treat dry eye syndrome, floaters, retinopathy, and various chronic eye diseases

1. Zidovudine (AZT): Currently the most effective drug, it can cross the blood-brain barrier. It selectively inhibits viral replication and proliferation. Clinical observations indicate it can prolong patients' lives but cannot cure the infection. Treatment methods for pediatric symptomatic HIV infection vary and can be selected as appropriate from the following:
   1. 120–240 mg/m², orally, every 6 hours, for 12 weeks; alternatively, 3–5 mg/kg, orally, every 4 hours.
   2. 80–160 mg/m², intravenous drip, every 6 hours, for 1–2 months.
   3. For central nervous system lesions, continuous intravenous drip is preferable. Reports suggest using 0.5–1.8 mg/(kg·h) to maintain plasma concentration levels >1.0 μmol/L. Side effects include significant bone marrow suppression and decreased hemoglobin. For intravenous drip doses >1.4 mg/(kg·h), granulocytopenia often occurs. Additionally, gastrointestinal reactions and liver damage may be observed.
2. Dideoxynucleoside compounds (dideoxycytidine-DDC, dideoxyinosine-DDI): These drugs are structurally and functionally similar to AZT, with good blood-brain barrier penetration, making them effective for AIDS encephalopathy. DDC 0.01–0.04 mg/kg, every 4 hours, intravenous drip or orally, with no hematological toxicity. Long-term use may cause peripheral neurotoxic reactions, and alternating use with AZT is beneficial. DDI 9.6 mg/(kg·d), divided into 2–3 doses.
3. Ampligen: Has immunomodulatory effects, can regulate HIV replication, is non-toxic, and when used with AZT, reduces toxic side effects.
4. Ribavirin has been observed to reduce disease onset in HIV carriers.
5. Interferon-α: Can inhibit HIV replication at the late stage (third stage) of spore formation and can be used in combination with AZT to treat Kaposi's sarcoma, with early treatment being effective. In recent years, the U.S. has conducted gene therapy research for neonatal HIV infection, synthesizing anti-HIV viral genes and using retroviruses as vectors to insert them into umbilical cord blood hematopoietic stem cells, enabling the proliferated and differentiated cells to resist HIV replication, potentially offering therapeutic benefits.

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TCM's treatment of atopic dermatitis is more comprehensive, fundamental, non-toxic and effective than Western medicine's symptomatic treatment

1. Antibiotics are selected for treating bacterial infections.
2. Acyclovir, among others, is used to treat cytomegalovirus and other infections.
3. SMZco is used to treat Pneumocystis carinii infections.
4. Vincristine and interferon can be used to treat Kaposi's sarcoma, while advanced cases may be treated with doxorubicin, bleomycin, vinca alkaloids, or VP-16 in combination chemotherapy. Electron beam radiotherapy is also effective.

To improve immunodeficiency conditions, immunomodulators have been trialed in recent years for AIDS treatment. For example, intravenous high-dose gamma globulin can regulate and improve immune status during severe infections. The use of IL-2, γ-interferon, thymosin, thymic humoral factor, and lymphocyte transfusions has yielded unsatisfactory results thus far.

bubble_chart Prevention

1. Use blood products and related biological products (such as Factor VIII and gamma globulin) with caution.
2. Preventing AIDS is particularly important for couples of childbearing age.
3. HIV is poorly resistant to detergents, heat, drying, and disinfectants. It can be inactivated at 56°C for 30 minutes, but ultraviolet light has no inactivating effect. 75% alcohol, 3% hydrogen peroxide, and 10% bleach can be used as disinfectants.
4. When healthcare workers are injured by contaminated needles or blades, AZT treatment should be initiated within 2 hours and continued for 4–6 weeks.

bubble_chart Differentiation

This disease must be differentiated from various congenital immunodeficiency diseases, acquired infectious immunodeficiency diseases, especially various CD4+ T lymphocytopenia disorders.