HIV treatment in children

Derek Thaczuk

In its 2008 report, UNAIDS estimated two million children under the age of 15 are living with HIV/AIDS, 90% of whom live in sub-Saharan Africa. In 2007, approximately 370,000 new infections were diagnosed in children and mortality attributed to HIV infection was 270,000. Of the new cases, 89% were in children living in sub-Saharan Africa, as were 90% of the deaths.1

Most new HIV infections in children are a result of mother-to-child transmission. Transmission is largely preventable in settings where testing and antiretroviral drugs are available. Unfortunately, many HIV-infected pregnant women are not diagnosed in time to receive antiretroviral treatment for their own health, much less that of their infants. In the latest reports from low- and middle-income countries, 85% of infants are not tested for HIV infection in the first two months of life. Most paediatric deaths from HIV infection occur in young children who never received testing or treatment.2

HIV infection is more aggressive in newborns and children. One report estimates that in the absence of antiretroviral therapy and/or cotrimoxazole, 35% of HIV-infected children will die in the first year of life and 53% before the age of two, as compared to a mortality rate of 5% and 8% respectively in HIV-uninfected infants.3 In both cases, infant death is also attributable to poverty and its effects: unclean water, poor sanitation, inadequate nutrition, and limited access to health care. 

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

In low- and middle-income countries, significant strides have been made in several areas. By the end of 2008, 45% of pregnant women with known HIV infection received ART to prevent transmission. Roughly 38% of the estimated 730,000 children in need of ART received it; representing a 39% increase over the previous year. There was also an 80% increase in the number of facilities providing HIV treatment to infants and children.4 

Guidelines

It is recommended that clinicians regularly access the guidelines they use through the internet, when possible, so that the most up-to-date information on testing, diagnosis, and treatment is used in clinical decision-making.

The World Health Organization (WHO) has many publications and resources, including testing and treatment guidelines, recommended interventions for scaling-up HIV services, and healthcare worker training curricula. Some key documents are listed below and all can be accessed online through the WHO portal at www.who.int/hiv. Additional regional guidelines, available in several languages, are also available on their website.

In the United States, the working group on antiretroviral therapy and medical management of HIV-infected children and working group on guidelines for the prevention of opportunist infections among HIV-exposed and HIV-infected children regularly review and update the following publications:

The Paediatric European Network for the Treatment of AIDS (PENTA) has updated guidelines, intended for treating children with HIV in Europe, available on their website. 

  • PENTA 2009 guidelines for the use of antiretroviral therapy in paediatric infection. Intended as recommendations for treating children with HIV infection in Europe.5 Online at www.pentatrials.org/guide08.pdf

The Children's HIV Association of UK and Ireland (CHIVA) ) have guidelines for HIV testing, diagnosis, management, adherence, and prevention on their website www.chiva.org.uk/health/guidelines. Among these are:

The African Network for the Care of Children affected by AIDS (ANECCA) has many resources available on their website, www.anecca.org including newsletters, specific country information, and curricula for healthcare workers, as well as the updated version of:

  • Handbook on Paediatric AIDS in Africa, revised edition, July 2006.  

References

  1. UNAIDS 2008 report on the global HIV/AIDS epidemic. Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva. (www. unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008, 1-357), 2008
  2. World Health Organization and UNICEF Scale up of HIV-related prevention, diagnosis, care and treatment for infants and children, a programming framework. WHO: Geneva, pp 1-80 (www.unicef.org/aids/files/OMS_PAEDS_Programming_Frameworks_WEB.pdf, 1-80, accessed 8 October 2009), 2008
  3. Newell ML et al. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet 364: 1236-1243, 2004
  4. World Health Organization, UNAIDS, and UNICEF Scaling up priority HIV/AIDS interventions in the health sector. Progress report. WHO: Geneva, 1-165. (data.unaids.org/pub/Report/2009/20090930_tuapr_2009_en.pdf, accessed 10 October 2009), 2009
  5. Welch S et al. PENTA 2009 guidelines for the use of antiretroviral therapy in paediatric HIV-1 infection. HIV Med 10(10) 591-613, 2009
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.