A 5-year-old boy is brought to the physician by his parents for a routine examination. He and his parents are HIV-positive. The patient is currently taking antiretroviral medication. His HIV viral load is undetectable, and he has not had any AIDS-defining illnesses. The patient's medical history is otherwise unremarkable. He has met all developmental milestones and is up-to-date on his vaccinations. Physical examination is unremarkable. The parents ask what impact their son's HIV-positive status will have on his upcoming enrollment in kindergarten. Which of the following is the most appropriate response?

Question

A 5-year-old boy is brought to the physician by his parents for a routine examination.  He and his parents are HIV-positive.  The patient is currently taking antiretroviral medication.  His HIV viral load is undetectable, and he has not had any AIDS-defining illnesses.  The patient's medical history is otherwise unremarkable.  He has met all developmental milestones and is up-to-date on his vaccinations.  Physical examination is unremarkable.  The parents ask what impact their son's HIV-positive status will have on his upcoming enrollment in kindergarten.  Which of the following is the most appropriate response?

Quizplus · Accepted Answer

Explanation: Both the American Academy of Pediatrics and the National Association of State Boards of Education recommend that HIV-positive children attend public school in a normal manner (ie, commingling with other students in the classroom and on the playground) as HIV is not transmitted through casual contact but rather through exposure to blood, semen, vaginal fluid, or breast milk. The recommendation includes that children may participate in all sports. Standard precautions, including the use of gloves when in contact with blood or mucous membranes, are sufficient to preclude transmission of HIV. Furthermore, there is no requirement for this family to disclose their son's HIV status to the school. However, it may be beneficial to have this patient's teacher and school nurse be aware of his HIV-positive status so that they can monitor for infections in other children who may put the HIV-positive child at risk. In rare instances, exclusions can be instated if an HIV-positive child has aggressive tendencies (ie, biting). Such issues should be resolved before the child is enrolled in school. (Choice A) There is no requirement for mandatory reporting, which would be a violation of health privacy laws. Voluntary reporting to this patient's teacher and school nurse is reasonable if the family is comfortable doing so. (Choice B) HIV is not a contraindication to contact sports. For any athlete, visible blood should be immediately cleaned and covered, and trainers should wear gloves whenever contact with blood or body fluids is possible. (Choices D and E) School exclusion due to HIV-positive status, regardless of viral load, is not medically reasonable as HIV is not transmissible through casual contact. Furthermore, the Americans with Disabilities Act prevents school exclusion due to medical conditions, including HIV infection. Educational objective: HIV-positive children should attend school in a normal manner (ie, commingling with other students in the classroom and on the playground) and may play sports. Any disclosure of HIV status by the family is voluntary.

A 5-Year-Old Boy Is Brought to the Physician by His