Children with unrecognized human immunodeficiency virus infection. An emergency department perspective

J. A. Fein, L. R. Friedland, R. Rutstein and L. M. Bell
Section of Emergency Medicine, Children's Hospital of Philadelphia, University of Pennsylvania 19104.

OBJECTIVE--To provide an approach toward the diagnosis of children with human immunodeficiency virus (HIV) infection in the acute care setting. DESIGN--Patient reports and review of recent literature. SETTING--Emergency departments or acute care clinics. SELECTION PROCEDURES--Analysis of important recent clinical publications. INTERVENTIONS--None. RESULTS AND CONCLUSIONS--The clinical and historical findings associated with pediatric HIV infection are occasionally subtle and differ from those findings in adults. In this article, we have divided the first presentation of HIV in the acute care setting into five categories: recurrent bacterial infections, failure to thrive, unexplained organomegaly, adolescents with HIV, and late presentation of perinatally acquired HIV. Each category is illustrated by a patient treated in the acute care setting. Recognition of these categories of presentation will hopefully assist acute care physicians in the early diagnosis of HIV infection.