Eighty per cent of children with AIDS acquire their infection perinatally from infected mothers. Symptoms and signs appear in the first year of life and include failure to thrive, an increased number of bacterial infections, hepatomegaly, splenomegaly, lymphadenopathy, and progressive encephalopathy. Serious and multiple opportunistic infections are the rule. Antibody tests are difficult to interpret in the first year of life because of the presence of transmitted maternal antibodies. Management includes vigorous therapy for infections and attention to caloric intake and other aspects of child life, that is, foster care, day care, and schooling. Specific antiretroviral therapy is not yet established. Monthly intravenous immunoglobulin and sulfa-trimethoprim are recommended to prevent infections. The key to prevention is education.
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