Chapter 1

The Facts
What is AIDS?

AIDS stands for acquired immunodeficiency syndrome, a

pattern of devastating infections caused by the human
immunodeficiency virus, or HIV, which attacks and destroys
certain white blood cells that are essential to the body's
immune system.
When HIV infects a cell, it combines with that cell's genetic
material and may lie inactive for years. Most people infected
with HIV are still healthy and can live for years with no
symptoms or only minor illnesses. They are infected with HIV,
but they do not have AIDS.
After a variable period of time, the virus becomes activated
and then leads progressively to the serious infections and other
conditions that characterize AIDS. Although there are treatments
that can extend life, AIDS is a fatal disease.
Research continues on possible vaccines and, ultimately, a cure.
For the moment, however, prevention of transmission remains
the only method of control.

The route of infection in adults

HIV targets two groups of white blood cells called CD4+

lymphocytes and monocytes/ macrophages. Normally, CD4+
cells and macrophages help recognize and destroy bacteria,
viruses or other infectious agents that invade a cell and cause
disease. In an HIV-infected person, the CD4+ lymphocytes are
killed by the virus, while the macrophages act as reservoirs,
carrying HIV to a number of vital organs.
HIV attaches itself to the CD4+ lymphocyte and makes its
way inside. This causes the cell to produce more HIV but, in
doing so, the cell is destroyed. As the body's CD4+ cells are
depleted, the immune system weakens and is less able to fight
off viral and bacterial infections. The infected person becomes
susceptible to a wide range of "opportunistic" infections, such
as
Pneumocystis carinii pneumonia, which rarely occurs in
persons with normal immune systems. Tuberculosis (TB)
poses a particular threat to HIV-positive people, especially in
areas of the world where both TB and HIV infection are
increasing at alarming rates. Millions of TB carriers who would
otherwise have escaped active tuberculosis are now
developing the disease because their immune systems are
under attack from HIV. TB also progresses faster in HIV-
infected persons, and is more likely to be fatal if undiagnosed
or untreated. TB is now the leading killer of HIV-infected
Africans.
HIV-infected persons are also more susceptible to
otherwise rare cancers such as Kaposi’s sarcoma, a
tumour of the blood vessels or the lymphatic vessels. HIV may
also attack the brain, causing neurological and neuro-
psychiatric problems.
In general, about 50 percent of HIV-infected adults are likely
to develop AIDS within 10 years after first becoming infected.
The good news is that early treatment with improved drugs is
significantly prolonging life for persons with AIDS.

The route of infection in infants and children

Most HIV-infected infants and children acquired the

infection from their mothers before, during or shortly after birth,
or during breastfeeding. Only a small proportion are infected
through HIV-contaminated blood transfusions or injections.
There are two patterns of disease progression in children
infected from birth. About half these children progress rapidly to
AIDS, but others remain symptom free for years, as adults do.
Studies show that, in developed countries, approximately two-
thirds of infected children are still alive at age 5 years. In
developing countries, the figure ranges between 30 and 65
percent. (For more information, see the section on mother-to-
child transmission of HIV later in this chapter.)
How HIV is transmitted
To date, there are only four primary methods of
transmission: sexual intercourse (anal and
vaginal);
contaminated blood and blood products, tissues
and organs; contaminated needles, syringes and
other piercing instruments; and mother-to-child
transmission (MTCT).
Sexual intercourse

HIV can be transmitted through unprotected sexual

intercourse—that is, any penetrative sexual act in which a
condom is not used. Anal and vaginal intercourse can transmit
the virus from an HIV-infected man to a woman or to another
man, or from an infected woman to a man.
The risk of becoming infected through unprotected sexual
intercourse depends on four main factors: the probability that
the sex partner is infected, the type of sex act, the amount of
virus present in the blood or sexual secretions (semen, vaginal
or cervical secretions) of the infected partner, and the presence
of other sexually transmitted diseases and/or genital lesions in
either partner. Age may also be a factor as young girls are
physiologically more vulnerable.

The probability of HIV infection in the partner

The prevalence of HIV infection among sexually active men

and women varies according to geographical area or
population subgroup, such as heterosexuals, men who have
sex with men (MSM), sex workers, or injecting drug users (see
page 36). Generally, the likelihood of becoming infected with
HIV sexually is related to the number of sexual partners and
unprotected sex acts you have. In other words, the more
sexual partners you have, the greater your chance of becoming
infected.
The type of sex act
 All unprotected acts of sexual
penetration (anal, vaginal, oral) carry a
risk of HIV transmission because they
bring body fluids secreted during sex
directly into contact with exposed
mucous membranes (the lining of the
rectum, the vagina, the urethra and the
mouth).
Men and women who engage in
unprotected receptive anal
intercourse with an HIV-infected
partner run the highest risk of
becoming infected.
The next highest risk is that associated
with unprotected vaginal intercourse.
Unprotected oral intercourse involves
some risk as well, particularly if
there are mouth or throat injuries
present such as bleeding gums,
lesions, sores, abscessed teeth,
throat infections, oral gonorrhoea or
other STDs present.
This risk is reduced, although not entirely eliminated, by the
proper use of condoms. Injury to the mucous membrane of the
rectum, vagina or mouth may help the virus enter the
bloodstream. However, HIV can be transmitted even through
unbroken mucous membrane.
Kissing has not been shown to transmit HIV, as
saliva contains very little of the virus. Nevertheless,
there is a theoretical risk of HIV transmission during
deep or "wet" kissing (tongue kissing) if blood from
gum or mouth sores is present in the saliva. There is
no evidence that HIV has actually been transmitted
this way.
 Self-masturbation involves no risk of HIV transmission.
There are no known cases of transmission through mutual
masturbation, either. However, masturbation of a partner poses
a theoretical risk of HIV transmission if his or her sexual
secretions come in contact with mucous membrane or broken
skin.
The amount of virus present in the infected partner

HIV-infected individuals become more infectious as they

progress to HIV-related disease and AIDS. There is also an
early one- to two-week period of infectiousness around the time
of seroconversion—that is, when antibodies first develop.

The presence of other sexually transmitted

diseases in either partner

There is a strong link between sexually transmitted

diseases (STDs) and the sexual transmission of HIV infection
(3). The presence of an untreated STD—such as gonorrhoea,
chlamydial infection, syphilis, herpes or genital warts—can
enhance both the acquisition and transmission of HIV by a
factor of up to 10. Thus, STD treatment is an important HIV
prevention strategy in a general population.

Contaminated blood or blood products,

tissues and organs

Blood transfusions save millions of lives each year, but in

places where a safe blood supply is not guaranteed, those
receiving transfused blood have an increased risk of being
infected with HIV.
In most industrialized countries, the risk of acquiring HIV
infection from transfusions is extremely low. This is due in large
part to effective recruitment of regular, volunteer blood donors;
improved donor testing procedures; universal screening of
blood and blood products with highly sensitive and specific
tests for the antibody to HIV; and the appropriate use of blood.
 In the developing world, however, the risk is much higher.
One estimate is that up to 5 percent of HIV infections may be
caused by transfusions in high-prevalence areas such as sub-
Saharan Africa. The lack of coordinated national blood
transfusion systems, the absence of non-remunerated
volunteer blood donors, lack of testing, and inappropriate use
of blood products compound the problem (4-6).
To prevent transmission by tissue and organ donation,
including sperm for artificial insemination, the HIV-infection
status of the donor should be carefully evaluated.

Contaminated needles, syringes or

other piercing instruments

HIV can be transmitted through the use of HIV-

contaminated needles or other invasive instruments. The
sharing of syringes and needles by injecting drug users is
responsible for the very rapid rise in HIV infection among these
persons in many parts of the world.
A risk is also attached to non-medical procedures if the
instruments used are not properly sterilized. Such procedures
include ear- and body-piercing, tattooing, acupuncture, male
and female circumcision, and traditional scarification. The
actual risk depends on the local prevalence of HIV infection.
HIV transmission by means of injection equipment can also
occur in health care settings where syringes, needles and other
instruments, such as dental equipment, are not properly
sterilized, or through injury by needles and other sharps.

Mother-to-child transmission (MTCT)

Mother-to-child transmission (MTCT) is the overwhelming

source of HIV infection in young children. The virus may be
transmitted during pregnancy, labour, delivery or after the
child's birth during breastfeeding. Among infected infants who
are not breastfed, most MTCT occurs around the time of
delivery (just before or during labour and delivery). In
populations where breastfeeding is the norm, breastfeeding
may account for more than one-third of all cases of MTCT
transmission (7,8).
Paediatric AIDS can be difficult to diagnose because some
symptoms of HIV infection, such as diarrhoea, are also
common in infants and children who are not infected.
Therefore, these symptoms cannot be considered a reliable
basis for diagnosis. There are blood-based tests that allow
early diagnosis of HIV infection in infants. These are used
extensively in developed countries. However, these tests are
quite expensive and are not readily available in developing
countries.
How HIV is not transmitted
Family, friends and co-workers should not fear becoming
infected with HIV through casual contact with an HIV-infected
person at home, at work, or socially. These activities will not
transmit the virus:
shaking hands, hugging or kissing (see paragraph on deep
kissing, page 14)
coughing or sneezing
using a public phone
visiting a hospital
opening a door
sharing food, eating or drinking utensils
using drinking
fountains using
toilets or showers
using public swimming
pools getting a mosquito
or insect bite.
AIDS and work

For the vast majority of occupations, the workplace does

not pose a risk of acquiring HIV. The exceptions include
laboratory workers, health care workers, persons dealing with
hospital waste products, emergency medical response
personnel and any other occupation where there is a possibility
of exposure to blood. Their risk is very low, but real. Among the
hazards to which these persons may be exposed are
needlestick injuries and other skinpiercing accidents, and blood
splashing into the eyes while they are administering treatment
or otherwise performing their duties.

AIDS and sports

There are no documented cases of HIV being transmitted

during participation in a sports activity. The very low risk of
transmission during sports participation would involve sports
with direct body contact in which bleeding might be expected to
occur (10).
It is theoretically possible for the virus to be transmitted if an
HIV-infected athlete had a bleeding wound or skin lesion with
fluids that came in contact with another athlete's skin lesion, cut
or exposed mucous membrane. Even in such an unlikely event,
risk of transmission would be very low. However, in sports
involving direct body contact or combative sports where
bleeding might occur, it is sensible to follow two simple
procedures:
cleanse any skin lesion with antiseptic and cover it securely;
and
if a bleeding injury occurs, interrupt participation until the
bleeding has stopped and the wound has been both
cleansed with antiseptic and securely covered.
Chapter 2
Preventing HIV
Transmission
Preventing sexual transmission of HIV

Know your partner

Whether you are male or female—heterosexual,

homosexual or bisexual—your risk of acquiring HIV infection is
directly related to the likelihood that your partner is infected.
Your risk is substantially higher if your partner has ever injected
drugs, has unprotected sex with casual partners, or has a
sexual history unknown to you.

Understand which sexual acts put you at most

risk

All forms of penetrative sexual intercourse (anal, vaginal,

oral) with an HIVinfected man or woman carry a risk of
transmission. Unprotected anal intercourse is one of the
riskiest practices. This is true even when a condom is used
because of the increased likelihood that the condom will be
damaged during this form of sex. Unprotected vaginal
intercourse carries the next highest risk of infection. Oral sex
also carries a small risk of transmission, particularly if there are
mouth or throat injuries present such as bleeding gums,
lesions, sores, abscessed teeth, throat infections, or oral STDs
present.
To protect yourself, always use a condom during
penetrative sexual acts (11).
Female condom

Or, to be even safer, you can engage in sexual practices

that involve no penetration such as caressing or massaging
any part of the body, masturbation (provided that sexual
secretions do not come in contact with cuts or sores on the
other partner's skin), and kissing that does not involve heavy
exchange of saliva and possibly blood. The safest course of all
is abstinence.

Seek medical advice or treatment for STDs

The presence of an untreated sexually transmitted disease

—such as gonorrhoea, chlamydial infection, syphilis, herpes or
genital warts—can enhance both your acquisition and
transmission of HIV by a factor of up to 10. If you suspect you
have an STD, or have been exposed to one, it is imperative
that you seek medical advice and treatment immediately.
Common symptoms include an unusual discharge from the
vagina or penis, burning or pain during urination, and sores or
blisters near the mouth or genitals. Other symptoms in women
may include unusual bleeding (other than the menstrual cycle)
and vaginal pain during intercourse.

Preventing transmission of HIV via

blood and blood products
In industrialized countries, the risk of transmission of HIV via
blood and blood products is very rare for each unit of blood
transfused.
It is also very rare to contract HIV in the health care setting.
For example, evidence from the USA indicates that health care
workers who accidentally puncture their skin with a needle
contaminated with HIV have an estimated risk of less than five
in a 1000 (0.5 percent) of developing HIV infection.
Also, HIV is a fragile virus, meaning it is vulnerable to
changes in temperature and other environmental factors, and
has been shown not to be viable in dried blood for more than
an hour. The concentration of virus particles of HIV per millilitre
of blood is also very low in contrast to other viruses. Despite
the low level of occupational risk posed by HIV, safe work
practices should be followed at all times by laboratory
personnel and health workers (14). Don't be afraid to ask your
health care professional, clinic or hospital if they follow
"universal precautions”, or safety measures to prevent the
transmission of HIV in health care settings.
If you must travel to areas of the world where the safety of
the blood supply is not guaranteed, you should follow these
measures (15,16):
before you travel, identify sources of reliable medical help in
your destination country;
carry sterile disposable needles and syringes for your
personal use (as part of the WHO medical kit);
be aware of emergency medical evacuation procedures;
reduce your risk of injury by following safety precautions
such as using seatbelts and driving carefully; and
if you are injured and lose blood, consider using a plasma
substitute (crystalloids/colloids). If severe or acute blood
loss has occurred, efforts should be made to ensure that
the blood has been screened for HIV and hepatitis B virus.

Preventing transmission of HIV via

contaminated needles

Avoid invasive, skin-piercing procedures

Ear- or body-piercing, tattoos, acupuncture or any

procedure that requires invasive, skin-piercing instruments
carry some risks of transmission. If you are considering any of
these procedures, make sure that all equipment is properly
sterilized. Do not be afraid to ask questions of the technician or
health care personnel. HIV is easily destroyed by heat;
instruments should be sterilized by steam or by dry heat.
If this is not possible, instruments should be disinfected by
boiling (17).
Protecting children
Parents should make sure that children know the facts about
HIV transmission and how they can protect themselves against
infection. Specifically, children should:
be aware that HIV is transmitted through blood;
avoid any skin-piercing procedures or accidental injury from
unsterilized needles and other sharp instruments;
receive injections or other medical or dental treatment only
when necessary and only with properly sterilized
equipment;
receive blood transfusions only when medically necessary
and only with properly screened blood; and
avoid the risk of traumatic injury necessitating blood
transfusion.
Older children need information and encouragement that
will help them avoid becoming infected through unprotected
sexual intercourse or through sharing druginjecting equipment.
Children also need to be reassured about the ways in which
HIV cannot be transmitted (see Chapter 1).
They should be encouraged to be sympathetic toward
children and adults who are infected, and should not fear
becoming infected through casual contact with these persons.
Chapter 3
Being Tested
What the HIV antibody test can tell
you
The standard tests to determine whether you are infected with
HIV are based on detection of antibodies to HIV in the blood,
not of the virus itself (11). Different types of antibody tests exist
such as the enzyme-linked immunosorbent assay (ELISA) and
simple rapid (S/R) tests. In recent years, tests have been
developed that detect HIV antibodies in saliva and urine.
The first antibody test a person gets is called a screening
test. If the screening test is negative, it means that no
antibodies were found. The person tested is considered HIV-
negative and confirmatory tests are not necessary. If the
screening test is repeatedly positive, it must be confirmed.
Confirmation can be done by using special tests, e.g. Western
Blot or line immunoassays (LIA). It is also possible to confirm a
positive result by using combinations of ELISA or S/R tests.
Although the confirmation can be done on the same sample of
blood, it is preferable to do the confirmation on a second blood
sample in order to avoid any errors.
HIV screening tests can sometimes give false-positive
readings, especially in populations where HIV is not present in
high numbers, which is why confirmatory testing is always done
on positive screening test results. This confirmation is needed
to rule out false-positive screening results.
In regard to the accuracy of the antibody tests:
It takes, on average, 25 days for an HIV test to show positive
after a person becomes infected with HIV. This is a much
shorter timeframe than before the introduction of very
sensitive tests now used.
If a person has been infected very recently, the test may
show a negative result.
 When saliva and urine are tested, it takes longer for
antibodies to become detectable.
More than 99 percent of infected persons will show positive
after three months.

The HIV antibody test and

employment
In the vast majority of occupations and occupational settings,
work does not involve a risk of transmitting HIV between
workers or from worker to client. The following
recommendations have been put forward on AIDS and the
workplace.

Information for United Nations Employees and Their

Families — 25

Pre-employment HIV/AIDS testing as part of assessing

fitness to work is unnecessary and should NOT be
required. This applies to both direct methods such as HIV
testing and indirect assessment of risk behaviours and
questioning the applicant about HIV tests already taken.
Pre-employment HIV/AIDS screening for insurance or other
purposes raises serious concerns about discrimination, and
merits close scrutiny.
For persons currently employed, HIV/AIDS screening,
whether direct or indirect, should NOT be required.
All medical information, including HIV/AIDS status, must be
kept confidential.
Employees should not be required to inform the employer
regarding their HIV/AIDS status.
Persons in the workplace who are HIV-infected (or perceived
to be) must be protected from stigmatization and
discrimination by co-workers, unions, employers and
clients. Information and education are essential to maintain
a climate of mutual understanding necessary to ensure this
protection.
 HIV-infected employees should not be discriminated against
with respect to their access to and receipt of benefits from
statutory social security programmes and occupationally-
related schemes.
HIV infection alone does not limit fitness to work. If fitness to
work is impaired by HIV-related illness, reasonable
alternative working arrangements should be made.
HIV infection is not a cause for termination of employment.
As with many other illnesses, persons with HIV-related
illnesses should be allowed to work for as long as they are
medically fit for available, appropriate work (18).
While these measures are designed to protect your rights if
you are HIV-infected, you also have a responsibility to adopt
behaviour that does not put others in your workplace at risk of
infection.

The HIV antibody test and pregnancy

If you or your partner are concerned about your HIV status, and
you are thinking about having a baby, the HIV antibody test
may help clarify your choices.
HIV testing should be available, with pre- and post-test
counselling, on a voluntary, confidential basis. You and your
sex partner should be counselled on the implications that a
positive test result will have for both of you, for the fetus and for
the infant if pregnancy is considered.

26 — AIDS and HIV Infection

An HIV-infected woman can transmit HIV to her infant. The

most likely time for an HIV-infected pregnant woman to pass
the virus on to her baby is either in the very early stages or in
the advanced stage of her infection. Thus, the risk of
transmission ranges from low (if the HIV-infected woman has
no signs and symptoms) to high (if she has AIDS). The
transmission rate ranges from 12% to over 30%.
 If you are pregnant and HIV-infected, you should be
counselled on the options of continuing or terminating your
pregnancy (where abortion is legal) and about reducing
mother-to-child transmission (MTCT) through treatment with
zidovudine (sometimes called ZDV or AZT) during your
pregnancy (see page 32 for more information).
Pregnancy does not appear to accelerate the progression of
the clinical course of HIV infection.
Chapter 4
Living with HIV and AIDS
Coping with confirmed HIV infection
Learning that you are infected with HIV will change your life
dramatically. You may experience a wide range of emotions—
fear, loss, grief, depression, denial, anger, anxiety. No matter
how reassuring the doctor, how effective drug therapies are
now and will become, how minimal the physical impact of the
infection, or how intellectually prepared you may be, your need
for counselling and support will be great.
The psychological issues faced by most persons with HIV
infection revolve around uncertainty. Your future hopes and
expectations, your relationships and your career will all require
some adjustment in order for you to cope with your illness and
lead a happy, productive life.

The impact on your health

The impact to your health is likely to depend on the stage of

infection you have reached when you discover you are
HIVpositive, the psychological support available to you, and
your access to good medical care.
Soon after becoming infected with the virus,
some people experience a brief flu-like illness
with fever, swollen lymph glands, skin rash or
cough. You may then remain perfectly fit and
healthy for many years despite being infected.
For approximately 50 percent of infected
persons, the time between becoming infected
and the appearance of the opportunistic
infections that characterize AIDS is more than
10 years.
Antiretroviral combination therapy, while expensive, has
been shown to slow the onset of AIDS and prolong life
expectancy. Your quality of life could also be improved by the
preventive and therapeutic use of drugs that fight off common
opportunistic infections and other diseases to which HIV-
infected person are vulnerable, such as tuberculosis. Active TB
screening and contact tracing through sputum examination are
also important for families with an HIV-positive member.
In addition to good medical care, psychological support—from
family, friends
and counselling—is critical. In many countries, there are
support groups made up of persons living with HIV and AIDS.
There are also numerous support groups and resources to be
found on the Internet (see Chapter 7).

The impact on your personal relationships

Partners are likely to suffer the consequences of HIV

infection and disease as much as the infected person, albeit
indirectly. This is so even if partners know that they are not
HIVinfected themselves. Their lives are likely to experience the
same kind of pressures and upheavals, and they can
experience similar feelings of uncertainty, grief, loss and anger.
Communication between the two partners and between
partners and professional counsellors is important to foster
understanding of the adjustments that will be needed. For
example, adjustments in sexual behaviour are necessary to
stop further

30 — AIDS and HIV Infection

transmission of infection. Counselling can also address the

physical and psychological changes and needs that the
partners will experience.
If you have HIV, you have an opportunity to make others
more aware of the disease. By educating others, you may
decrease the prejudice against persons with HIV or AIDS.
However, consider carefully to whom you reveal your HIV
status. Misunderstanding and discrimination do exist, and can
affect you and the ones you love. Again, professional
counselling can help with these issues.
Often, families are the main source of care and support for
HIV-infected persons, and the type of care required may
change depending on the stage of the infection. Counselling for
family members, both as individuals and as the family unit, can
be very important, particularly as the disease progresses.

The impact on your work life

How your work life is impacted will depend on how you feel
physically and mentally, and at what stage your infection is
discovered. Experience has shown that persons with HIV
infection, with or without symptoms, should keep working as
long as possible. After the initial period of coming to terms with
HIV infection, there usually comes a period of wanting to move
on with life—and work can be an important part of this
transition.
Although you are not obliged to inform your employer and
colleagues of your HIV status, certain circumstances may
make it necessary for you to do so. If your job calls for you to
travel, for example, you may need to go to countries where
entry depends on a certificate that shows you are not HIV-
infected. In addition, you may require certain vaccinations.
Theoretically, you could become infected by the "live" but
weakened pathogens in certain vaccines, particularly if your
immune system has already been damaged by HIV. It is
always best to consult your physician to determine the risks
involved with vaccines or if alternatives exist.
HIV and your infant's health

Having a baby

Pregnancy is something you and your partner will need to

discuss very carefully with your physician and possibly your
counsellor if either or both of you are infected. It is very
important to receive medical care early in your pregnancy.
 Your HIV treatment should not change very much from
what it was before you became pregnant. If you decide to
continue your pregnancy, talk with your doctor about how you
can prevent giving HIV to your baby. The chances of passing
HIV to your baby before or during birth are about 15-25
percent in developed countries and 25-45 percent in
developing countries. Treatment with zidovudine (sometimes
called ZDV or AZT) associated with replacement feeding has
been shown to greatly lower this risk.
Although you are pregnant, you should still use condoms
each time you have sex to avoid contracting other diseases
and to avoid spreading HIV. Even if your partner already has
HIV, he should still use condoms. After birth, your baby should
be tested for HIV, even if you took ZDV and/or other drugs
during pregnancy. Talk with your doctor about your baby's
special medical needs and any medications he or she will need
(19).

Breastfeeding

Breastfeeding is normally the best way to feed an infant.

However, if a mother is HIV-infected, it may be preferable to
replace breastmilk to reduce the risk of HIV transmission to
the infant.
The risk of replacement feeding should
be less than the potential risk of HIV transmission through
infected breastmilk, so that infant illness and death from other
causes do not increase. Otherwise, there is no advantage to
replacement feeding. According to joint guidelines from
UNAIDS, UNICEF and WHO (20), the following issues should
be considered:

32 — AIDS and HIV Infection

replacement feeding needs to provide all the infant's

nutritional requirements as completely as possible;
 breastmilk substitutes must be prepared and given
hygienically to avoid contamination with bacteria. This
requires access to clean water and fuel;
breastmilk substitutes must be affordable to families; and
affordable family planning must be accessible, as women
who do not breastfeed lose the child-spacing benefits that
breastfeeding can provide.

Childhood immunizations

Some parents may worry that their HIV-infected children

might be adversely affected by routine childhood
immunizations. In response, WHO and UNICEF have issued
the following guidelines. HIV-infected children should be
immunized against diphtheria, tetanus and pertussis (with
DTP); poliomyelitis (with OPV or IPV); and measles (with
measles vaccine), according to standard schedules. Children
with known or suspected HIV infection are at increased risk of
severe measles, and these children should be given an extra
dose of measles vaccine as soon after six months as possible,
with the scheduled dose given at nine months as usual.
Parents of HIV-infected children are often HIV-infected
themselves and have a higher incidence of tuberculosis than
the general population. Early protection against tuberculosis
with BCG immunization is therefore recommended for
HIVinfected children who are not symptomatic. Symptomatic
HIV-infected children, however, should not be immunized with
BCG (21) or yellow fever vaccine.