Children’s immune systems are still developing. They have a different response to HIV infection. CD4 cell counts (see fact sheet 124) and viral load counts (see fact sheet 125) are higher than in adults. An infant’s viral load usually declines after birth until age 4 or 5. Then it stabilizes.
Children also respond differently to ARVs. They have larger increases in CD4 cell counts and more diverse CD4 cells. They seem to recover more of their immune response than adults.
Infants have more fat and water in their bodies. This affects the amount of medication available. Children have a very high rate of metabolism. This gradually slows as they mature.
The liver processes drugs and removes them from the body. It takes several years to mature. As it matures, drug levels in children can change a lot. Many drugs have special dosage instructions for children.
Bones develop quickly during the early years of life. ARVs can weaken bones in adults. This was also seen in children. See Fact Sheet 557 for more information on bone problems in HIV.
It is very difficult to recruit children into HIV clinical trials. In the US, many children with HIV have already been in more than one research study. With falling infection rates, there are very few new cases of pediatric HIV. The US has considered ending support for its pediatric trials network. Important research questions may be studied in adults.
A recent study found that children born to HIV-positive mothers have high rates of psychiatric disorders.
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