Any clinician who sees sick children in an acute care setting may treat children with HIV and should be familiar with the atypical and sometimes life-threatening diseases that affect HIV-infected children. HIV-infected children are frequently seen in the emergency department (ED) [1]. HIV–infected children present to the ED with different complaints, are more likely to have diagnostic or therapeutic procedures performed and are more likely to be admitted to the hospital than uninfected children [2]. HIV status may not be known at the time of an ED visit. Manifestations of HIV infection may not be recognized [3, 4].

Even with the wide variety of antiretroviral therapies currently available, the quick recognition and aggressive treatment of the infectious complications of HIV infection in children may be life saving. Initial diagnosis of HIV infection may be made when a child presents with an acute and possibly life-threatening illness. Physicians must know the right questions to ask and the signs to look for. They must also be familiar with the appropriate evaluation and treatment options available to these children.

Emergency department presentation

History

HIV-infected children, whose diagnosis is unknown, may first present to the ED. Physicians must be familiar with historical factors that may put a parent or child at risk for HIV infection (Table 6.1). Today, almost all pediatric patients with HIV infection have perinatally acquired infections.