Paediatric HIV--trends & challenges

• Published in: Indian journal of medical research (New Delhi, India : 1994) India : 1994), 2011-12, Vol.134 (6), p.912-919
• Main Authors: Mothi, S N, Karpagam, S, Swamy, V H T, Mamatha, M Lala, Sarvode, S M
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral drugs; Antiretroviral Therapy, Highly Active - methods; Antiviral agents; Child; Children; Diagnosis; Disease Management; Diseases; Drug therapy; Health aspects; HIV; HIV infection; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - pathology; HIV Infections - transmission; HIV-1; Human immunodeficiency virus; Humans; Immunization Programs - methods; Infant; Infectious Disease Transmission, Vertical - prevention & control; Mortality; Review; Vaccines; Womens health
• ISSN: 0971-5916
• DOI: 10.4103/0971-5916.92636

With the availability of antiretroviral therapy (ART), HIV infection, which was once considered a progressively fatal illness, has now become a chronic treatable condition in children, as in adults. However, the challenges these children are forced to face are far more daunting. The most significant shortcoming in the response to paediatric HIV remains the woefully inadequate prevention of mother-to-child transmission (PMTCT), allowing a large number of children to be born with HIV in the first place, in spite of it being largely preventable. In the west, mother-to-child transmission has been virtually eliminated; however, in resource-limited settings where >95 per cent of all vertical transmissions take place, still an infected infants continue to be born. There are several barriers to efficient management: delayed infant diagnosis, lack of appropriate paediatric formulations, lack of skilled health personnel, etc. Poorly developed immunity allows greater dissemination throughout various organs. There is an increased frequency of malnutrition and infections that may be more persistent, severe and less responsive to treatment. In addition, these growing children are left with inescapable challenges of facing not only lifelong adherence with complex treatment regimens, but also enormous psychosocial, mental and neuro-cognitive issues. These unique challenges must be recognized and understood in order to provide appropriate holistic management enabling them to become productive citizens of tomorrow. To address these multi-factorial issues, there is an urgent need for a concerted, sustainable and multi-pronged national and global response.