Growing Up with HIV: Children, Adolescents, and Young Adults with Perinatally Acquired HIV Infection

Abstract

Tremendous success in the prevention and treatment of pediatric HIV in high-resource countries has changed the face of the epidemic. A perinatally HIV-infected child now faces a chronic disease rather than a progressive, fatal one. However, these successes pose new challenges as perinatally HIV-infected youth survive into adulthood. These include maintaining adherence to long-term, likely life-long therapy; selecting successive antiretroviral drug regimens, given the limited availability of pediatric formulations and the lack of pharmacokinetic and safety data in children; and overcoming extensive drug resistance in multi-drug-experienced children. Pediatric HIV care now focuses on morbidity related to long-term HIV infection and its treatment. Survival into adulthood of perinatally HIV-infected youth in high-resource countries encourages expansion of pediatric treatment programs in low-resource countries, where most HIV-infected children live, and provides important lessons about how the epidemic changes with increasing access to antiretroviral therapy for children.

Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

“…The impact of HAART on the reduction of progression to AIDS in children has been described repeatedly [2,3,5,8,10,22-24], even in developing countries [25-27]. However, few population-based studies have evaluated changes in the pattern of occurrence of diseases associated with HIV/AIDS [11,18,28,29].…”

“…Greater knowledge on the clinical course, early diagnosis of HIV infection, adoption of prophylaxis, improved management of opportunistic diseases, and introduction of antiretroviral therapy (ART) contributed to this trend [1-4]. New patterns of morbidity associated with chronic diseases have been described recently in HIV-infected individuals [5-7]. …”

Associations of Memory and Executive Functioning With Academic and Adaptive Functioning Among Youth With Perinatal HIV Exposure and/or Infection

“…Children and adolescents with perinatally acquired HIV (PHIV) are living longer, healthier lives [1] and must acquire academic and adaptive competencies for later success in adulthood. In general, children with PHIV perform in the low-average to average range on measures of global cognitive ability and adaptive behavior [2,3] but underperform relative to global cognitive ability on measures of academic achievement [4,5].…”

Late-stage diagnosis of HIV infection in Brazilian children: evidence from two national cohort studies

“…HIV replication plays an important role in disease pathogenesis 6,7 and early antiretroviral treatment (ART) in children has been shown to be associated with long-term control of HIV-1 replication and improved clinical and immunological outcomes 4,5,6 .…”

“…A study of children under the age of 12 months in the United States showed that highly active antiretroviral therapy (HAART) reduced mortality by 76%, and progression of the infection by 75% 5 , showing that this treatment changes the natural course of HIV infection in children 4 . New clinical and epidemiological patterns have been observed in both developed 8 and developing countries 9 .…”