Disease Progression in Children with Vertically-Acquired HIV Infection in Sub-Saharan Africa: Reviewing the Need for HIV Treatment

Abstract

Approximately 700,000 children become newly infected with HIV annually, mainly through mother-to-child transmission (MTCT), making paediatric HIV a leading cause of morbidity and mortality worldwide. The substantial interest in preventing MTCT (PMTCT) has generated information on rates of transmission and associated factors, but there is a lack of information on disease progression and mortality in vertically-infected children, especially from resource-poor settings. Peer-review journals with titles or abstracts containing reference to the review's themes were selected using widely available search engines. We review relevant literature on mortality in children born to HIV infected mothers; morbidity and mortality associated with paediatric HIV infections; eligibility to and efficacy of antiretroviral therapy (ART). Child mortality is independently associated with maternal HIV status and maternal death, with paediatric infection resulting in approximately 4 fold increase in mortality by age 2 years. Morbidities seen in infected children were similar to those seen in uninfected children, although the rates and recurrences of illness were greater. There is some evidence that progression to AIDS may be more rapid in resource poor settings, although data on this are very limited. PMTCT and paediatric ART have been shown to be highly successful in resource-limited settings, but are not universally applied. Further efforts to increase coverage of both PMTCT and paediatric ART could substantially reduce the numbers of children becoming infected and improve survival of those infected. Additionally, improvements in health infrastructures could improve care provision, not only through improved detection and monitoring but also through treatment of co-morbidities and nutritional support.

Temporal Trends in the Characteristics of Children at Antiretroviral Therapy Initiation in Southern Africa: The IeDEA-SA Collaboration

“…Timely ART initiation is important especially in infants and young children where disease progression is rapid and mortality is high [5], [6]. Even after ART initiation, early mortality remains very high in children with advanced disease, whereas starting ART with less advanced disease is associated with a good prognosis in terms of mortality, immunological, growth and neurodevelopmental outcomes [7], [8], [9], [10], [11], [12].…”

Obstetrical, maternal characteristics and outcome of HIV-infected rapid progressor infants at Yaounde: a retrospective study

“…It others setting very high mortality rate where found in infants who were not on ARV compared to those receiving ARV treatment (14). Death occurred in our study at a median age of 7 months; HIV infection increased the death rate before the age of 2 years considerably (39,40). The survival rate was low (43.3%) in children who were not treated, against 84.3% in those on ARV treatment.…”

The role of polymerase chain reaction in early diagnosis of human immunodeficiency virus infection in infants

“…This is because the maternal antibodies continue to circulate in the child for up to age 1 year and sometimes beyond. [11] The direct tests that assay the antigen or the antigenic component of the virus are more reliable and preferred in infants and children. Such direct tests include PCR, western blot, and viral culture.…”