In 2006, the World Health Organization (WHO) wrote that every day roughly 1,500 new cases of HIV are diagnosed in children under 15 years of age.^[1] Nearly 90% of those children live in the developing world. Effective prevention of mother-to-child transmission would be the most cost-effective means of reducing these numbers.

Without treatment, approximately one-third of all infected infants die in the first year of life. By the second year, it is estimated that half of those children will be dead. An unknown number of these deaths may also be attributable to poverty and its effects: unclean water supply, poor nutrition, and lack of access to healthcare. 

Antiretroviral treatment can dramatically change those rates, but obstacles to treatment include the cost of testing, availability and affordability of paediatric formulations of licensed ARVs, and medical and community infrastructure to care for HIV-infected infants and children.

Guidelines

Information provided in this section is taken from three sources. Clinicians are encouraged to use online internet guidelines whenever possible, so that the information sought is the most up-to-date available.

The World Health Organization has several publications on treatment of infants and children. The key guidelines are:

Antiretroviral therapy of HIV infection in infants and children: towards universal access, published in 2006 and available for download at www.who.int/hiv/pub/guidelines/paediatric020907.pdf

WHO Case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children, published in August 2006 and available online at www.who.int/hiv/pub/guidelines

Early detection of HIV infection in infants and children, Guidance note on the selection of technology for the early diagnosis of HIV in infants and children, published in May 2007 and available online at www.who.int/hiv/paediatic

WHO also offers additional regional guidelines, available in several languages on their website at www.who.int/hiv.

The United States Department of Health and Human Services keeps a living document (updated as needed and reviewed on a monthly basis) on their website. Guidelines for the use of antiretroviral agents in pediatric HIV infection was published in October 2006 and certain sections have been updated. That website can be accessed at: www.aidsinfo.nih.gov

The Children's HIV Association of UK and Ireland (CHIVA) endorses the guidelines set by the Paediatric European Network for the Treatment of AIDS (PENTA). The guidelines were written in June 2004 and updated in May 2007. The document title is PENTA guidelines for the use of antiretroviral therapy, 2004 and can be found online at: www.pentatrial.org/guidelin.pdf