Paediatric HIV - trends & challenges

Abstract

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.

Lack of susceptibility in neonatally infected rhesus macaques to simian immunodeficiency virus-induced encephalitis

“…Over 36.7 million persons were living with HIV in 2016, with children (< 15 years old) accounting for 2.1 million (AVERT 2018). In children infected with HIV surrounding birth (pre-, peri-, and post-parturition), there is a higher clinical incidence of neurologic disease and deficits than in adults infected with HIV; however, there is no pathological correlate in pediatric patients (Kure et al 1991;Vazeux et al 1992;Wilfert et al 1994;Westmoreland et al 1999;Mothi et al 2011). In agreement, SIV-infected neonatal rhesus macaques have decreased levels of infected macrophages and multinucleated giant cells (MNGCs), a hallmark of HIV encephalitis (HIVE) and simian immunodeficiency virus encephalitis (SIVE), and viral RNA is rarely detected in those cells (Sharer et al 1988;Lane et al 1996b;Westmoreland et al 1999).…”

Looking beyond prevention of parent to child transmission: Impact of maternal factors on growth of HIV-exposed uninfected infant

“…[1] It is estimated that there are between 22,000 and 61,000 HIV pregnant women living with HIV in India. [12] With improving prevention of parent to child transmission (PPTCT) program services, perinatal transmission of HIV has decreased and the vast majority of infants born to known HIV-infected mothers are HIV-exposed but uninfected. At the same time, there remains a huge gap between the number of estimated HIV infections in pregnant women versus those actually diagnosed and availing of PPTCT services.…”

“…[34] Resultant, a subset of HIV-infected pregnant women remains undiagnosed and untreated allowing disease progression, malnutrition, and immunosuppression. [1]…”

Anthropometry and body composition of vertically HIV-infected children and adolescents under therapy with and without protease inhibitors

“…The underlying social determinants of malnutrition may contribute to poor nutrition among these patients (27) . Common causes for inadequate nutrition are chronic illness, poverty, food insecurity and side-effects of drugs (35) . Most of the children and adolescents evaluated in the present study were from low-income backgrounds.…”