HIV treatment in children

UNAIDS estimates that 2.1 million children under the age of 15 are living with HIV/AIDS, 2 million of whom live in sub-Saharan Africa. For the year 2007, 420,000 children are believed to have been newly infected, most through mother-to-child transmission, which is largely preventable.[1] Infant and child mortality from HIV/AIDS was estimated at 290,000. Many of those children were never diagnosed or received treatment.[2]

Because HIV infection is more aggressive in newborns and children, in the absence of treatment it is estimated that one-third of all infected infants die in the first year of life and half by the age of two. 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.

Throughout this section, the main guidelines used are those from the World Health Organization (WHO) and the US Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children.[3][4]

Guidelines

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 (WHO) has many publications, 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 at www.who.int/hiv/. WHO also offers additional regional guidelines, available in several languages, at that site.

In the United States, the Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children is convened by the National Resource Center at the Francoise-Xavier Bagnoud Center, UMDNJ; the Health Resources and Services Administration (HRSA), and the National Institutes of Health (NIH). Their work is a living document, updated as needed, and reviewed on a monthly basis. Recent guidelines include:

  • Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. July 29, 2008. This also includes three supplements:  Pediatric Antiretroviral Drug Information, July 2008, Managing Complications of HIV Infection in HIV-Infected Children on Antiretroviral Therapy and Adverse Drug Effects, February 2008. aidsinfo.nih.gov/ContentFiles/PediatricGuidelines.pdf. 
  • Working Group on Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-Exposed and HIV-Infected Children. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children [DRAFT]. June 20, 2008.  aidsinfo.nih.gov/contentfiles/Pediatric_OI.pdf.

The African Network for the Care of Children affected by AIDS (ANECCA) has published a Handbook on Paediatric AIDS in Africa, revised editionJuly 2006. This publication, as well as newsletters, specific country information, and curricula for health care worker training can be found online at www.anecca.org.

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), PENTA guidelines for the use of antiretroviral therapy, 2004, written in June 2004 and updated in May 2007. This publication and other resources for paediatric care can be found online at www.pentatrials.org/home.htm

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