Pediatric human immunodeficiency virus infection and the acquired immunodeficiency syndrome. A health care crisis of children and families.

The number of children infected with the human immunodeficiency virus (HIV) is rapidly increasing. Most infected children acquire their infection by vertical transmission from an infected mother, and this increase in the number of infected children reflects a similar increase in the number of infected women. Many features of HIV infection in children differ from those in adults, and it is important for the physician to be familiar with the varied presentations of pediatric HIV infection. Transmission of HIV during adolescence, by sexual contact and illicit drug use, is also a growing problem, accounting for most cases of acquired immunodeficiency syndrome (AIDS) seen in young adults in their 20's. The HIV-infected child represents only one member of a family affected by the HIV virus; frequently, multiple other members of the family are infected as well. These families are predominantly underpriviledged, coming from inner city minority populations with limited access to medical care and social service support. Pediatric AIDS is a preventable disease, by the prevention of HIV infection in women. In short term, it is likely that education will have the greatest impact on altering the course of the AIDS epidemic. Most infected children are cared for in a limited number of public inner city hospitals, and the ability of these hospitals to continue to provide adequate care will be threatened by the rising number of cases. A multidisciplinary approach to providing care for these children and their families is essential, with the primary care physician coordinating this effort. Rapid advances in the treatment of HIV and its associated opportunistic diseases raise difficult questions concerning the access of women, including pregnant women, and children to clinical trials of investigational agents. The commitment of individual health care workers and an increased level of financial support will be necessary to provide the care that these children and their families require and deserve.