Communication Facts: Special Populations: Pediatric HIV/AIDS - 2008 Edition

Human Immunodeficiency Virus (HIV) is the virus that causes Acquired Immunodeficiency Syndrome (AIDS). This virus is passed from one person to another through blood-to-blood and sexual contact. Infection with HIV can weaken the immune system to the point that it has difficulty fighting off certain infections. Most of the individuals with HIV infection will develop AIDS as a result. As HIV attacks the central nervous system, individuals who are HIV-positive frequently experience speech, language, and hearing difficulties (1).

General Demographics

• As of 2005, there were 984,155 cases of AIDS in the United States that have been reported to the Centers for Disease Control and Prevention. Of these, 9,112 were children under age 13 (2).
• Of the AIDS cases reported as of 2005, 39% were among Whites, 40% were among Blacks or African Americans, 16% were among Hispanics or Latinos, and fewer than 1% were among Asian and/or Pacific Islanders, American Indians, and Alaska Natives (2).

Etiology of Pediatric HIV/AIDS

• Studies have indicated that 70% of HIV-infected women are sexually active and 25%-30% of HIV-infected women receiving medical care in North America express desires to have children (3).
• The advent of potent antiretroviral therapy coupled with advances in the understanding and treating of HIV infection has improved the life expectancy of women with HIV infection. Similarily, the use of antiretroviral drugs during pregnancy has resulted in a dramatic reduction in mother-to-child transmission of HIV (3).
• Almost all HIV-infected children acquire the virus from their mothers before or during birth, a process called perinatal transmission (4).
• Considerable progress has been made in understanding the natural course of HIV infection in children. Infected children differ from infected adults in several ways: rapid disease progression, higher viral loads, and recurrent invasive bacterial infections are among the characteristics (5).
• Regardless of how HIV is acquired, earlier age of onset typically causes more severe results. These consequences may affect cognitive, behavioral, and motor development (6).

Communication Manifestations of Pediatric HIV/AIDS

• Oral lesions are common in women and children with HIV/AIDS and may decrease the overall quality of life in these patients because of pain, dry mouth, and difficulty in eating. Oral lesions such as candidiasis, oral hairy leukoplakia, herpetic ulcers, and Kaposi's sarcoma are often among the first symptoms of HIV infection (7).
• Since HIV crosses the blood-brain barrier and impacts all aspects of an infected person's life, speech-language and hearing professionals need to be members of the interdisciplinary teams that assess and manage patients living with HIV (8).

Hearing

• The otolaryngological literature is replete with reports of AIDS/HIV-related infections and disorders, including otitis media, conductive and sensorineural hearing loss, recurrent bacterial infections and cholesteatoma (9-12).
• The effects of a hearing loss of any kind can have far-reaching consequences on communication in the pediatric AIDS population (13).
• There has been a higher reported incidence of nasopharyngeal polyps and subcutaneous cysts in patients with HIV. Nasopharyngeal masses can occlude the Eustachain tube and block ventilation which can contribute to the development of chronic otitis media (9).

Speech/Language/Voice

• Among the communication problems observed in those infected with HIV are speech, language, cognition and swallowing (14).
• Children with HIV have critical speech and language issues because the virus manifests itself primarily in the developing central nervous system, sometimes causing speech, motor control, and language disabilities (12).
• Elective mutism, hysterical aphonia, and pragmatic language disorders or delay appear to be unique manifestations in children with HIV (9).
• Language deficits are a major characteristic of neurobehavioral dysfunction in pediatric HIV disease. Impairments that develop during the second year of life seem especially severe. A decline in language skills may coincide with or precede other losses in cognitive ability (12).
• Thorough and regular assessment of the linguistic functioning of long term survivors of pediatric HIV disease is essential if optimal speech and language therapy management strategies are to be devised (15).

References

1. No author. (1999, August). AIDS patients often have hearing and speech problems. AIDS Alert, 14 (8): suppl 1-2.
2. Centers for Disease Control and Prevention. (2007, June 28). Basic statistics. <Accessed March 23, 2008 http://www.cdc.gov/hiv/topics/surveillance/basic.htm > .
3. Aaron, E.Z. & Criniti, S.M. (2007, August-September). Preconception health care for HIV-infected women. Topics in HIV Medicine, 15 (4):137-41.
4. Oxtoby, M.J. (1991). Perinatally acquired HIV infection. In P.A. Pizzo and C.M. Wilfert (Eds.), Pediatric AIDS: The challenge of HIV infection in infants, children, and adolescents (pp.3-21). Baltimore: Williams and Wilkins.
5. Saloojee, H. & Violari, A. (2001, September 22). HIV infection in children. British Medical Journal, 323: 670-674.
6. Armstrong, F.D., Sejdel, J.F., & Swaks, T.P. (1993). Pediatric HIV infection: A neuropsychological and educational challenge. Journal of Learning Disabilities, 26 (2): 92-103.
7. Gennaro, S., Naidoo, S. & Berthold, P. (2008, January-February). Oral health & HIV/AIDS. The American Journal of Maternal Child Nursing, 33 (1):50-7.
8. McNeilly, L.G. (2005, July-August). HIV and communication. Journal of Communication Disorders, 38 (4):303-10.
9. Zuniga, J. (1999, April). Communication disorders and HIV disease. Journal of the International Association of Physicians in AIDS Care, 5 (4): 16-23.
10. Scott, G.S. & Layton, T.L. (1997, July). Epidemiologic principles in studies of infectious disease outcomes: Pediatric HIV as a model. Journal of Communication Disorders, 30:303-322.
11. Layton, T.L., & Davis-McFarland, E. (2000). Pediatric human immunodeficiency virus and acquired immunodeficiency syndrome: An overview. Seminars in Speech and Language, 21 (1): 7-17.
12. Retzlaff, C. (1999, December). Speech and language pathology and pediatric HIV. Journal of the International Association of Physicians in AIDS Care, 5 (12): 60-62.
13. Scott, G.S., & Layton, T. (2000). Human immunodeficiency virus (HIV) infection in children. In T. Layton, E. Crais, & L. Watson (Eds.), Handbook of Early Language Impairments in Children: Nature (pp.317-353). Albany: Delmar Publishers.
14. Mathew, M. & Bhat, J. (2007, November). Voice disorders in HIV-infected individuals: a preliminary study. International Journal of STD & AIDS, 18 (11):732-5.
15. Hodson, A., Mok, J., & Dean, E. (2001). Speech and language functioning in paediatric HIV disease. International Journal of Language and Communication Disorders, 36 (suppl.): 173-178.

Compiled by Andrea Castrogiovanni * American Speech-Language-Hearing Association * 2200 Research Boulevard, Rockville, MD 20850 * acastrogiovanni@asha.org