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Children’s lives can be saved if HIV treatment starts earlier
Efforts worldwide on access to treatment for children with HIV have reached a new milestone, with 355 000 children receiving life-saving HIV treatment at the end of 2009, compared to 276 000 at the end of 2008; but many more lives could be saved if more infants started on medication earlier according to new recommendations from WHO.
Promoting healthier lives for infants and children
“It is encouraging that more children are getting access to HIV treatment, but we have opportunities to do more to promote healthy lives for infants and children,” says Dr Hiroki Nakatani, Assistant Director-General for HIV/AIDS, TB, Malaria and Neglected Tropical Diseases at WHO.
Until now, very few children under the age of one year have been started on HIV treatment, partly because the testing needed for this group has not been available in many settings. Expanding that availability of diagnostic testing is still often a critical need and WHO is calling for greater access to infant diagnosis starting at four to six weeks after birth. Without diagnosis followed by prompt initiation of treatment, an estimated one-third of HIV-infected infants will die before their first birthday, and about half will die before reaching two years of age.
“With early diagnosis and prompt treatment, children have far better chances of surviving,” says Dr Gottfried Hirnschall, WHO Director of HIV/AIDS.
Recommendations for reducing new HIV infections
While seeking to optimize the timing and approach to HIV treatment in infants and children who have already been infected, WHO has made new recommendations with the objective of reducing and eventually eliminating new HIV infections in children.
Approximately 400 000 infants acquire HIV infection each year as a result of mother-to-child transmission. To reduce this risk WHO recommends that all women with HIV should receive antiretroviral drugs to protect against HIV transmission during pregnancy, delivery or breastfeeding.
“We know what to do. Ending transmission of HIV from mothers to children is entirely achievable and must be a priority,” said Jimmy Kolker, Chief of HIV and AIDS for UNICEF.
There is good evidence that earlier and more effective treatment can prevent nearly all mother-to-child transmissions.
“Virtual elimination of mother to child transmission of HIV by 2015 is possible,” said Dr Paul De Lay, UNAIDS Deputy Executive Director, Programmes. “Relatively small investments can go a long way in saving mothers and babies.”
The recommendations on infants dovetail with WHO’s new recommendations for women with HIV, which advise earlier treatment for all eligible women, including pregnant mothers.
“The child’s health is inextricably linked with the health of its mother,” Dr Hirnschall says. “Ensuring HIV-positive mothers have access to treatment for their own health will greatly improve outcomes for their children.”
Breastfeeding, which is essential for child survival has posed an enormous dilemma for mothers living with HIV. Now, WHO says mothers may safely breastfeed provided that they or their infants receive ARV drugs during the breastfeeding period. This has been shown to give infants the best chance to be protected from HIV transmission in settings where breastfeeding is the best option.
Paediatric HIV and treatment of children living with HIV
An estimated 2.1 million children were living with HIV/AIDS at the end of 2007, 2 million of them in sub-Saharan Africa. Most of these children acquire HIV from their HIV-infected mothers during pregnancy, birth or breastfeeding. With successful interventions the risk of mother-to-child HIV transmission can be reduced to 2%. However, such interventions are still not widely accessible or available in most resource-limited countries where the burden of HIV is highest, and an estimated 1000 children get newly infected with HIV each day. The number of children receiving ART increased from about 75 000 in 2005 to almost 200 000 in 2007.
WHO develops normative guidance for use by policymakers and programme managers and provides support for governments and national stakeholders in developing and implementing HIV prevention, testing, care and treatment services for children.
Antiretroviral therapy for HIV infection in infants and children
Recommendations for a public health approach (2010 revision)
These treatment guidelines serve as a framework for selecting the most potent and feasible first-line and second-line ART regimens for the care of HIV-infected infants and children.
These guidelines address the diagnosis of HIV infection and consider ART in different situations, e.g. where infants and children are coinfected with HIV and TB, or have been exposed to ARVs, either for PMTCT or because of breastfeeding from an HIV-infected mother on ART. In addition, these guidelines address the importance of nutrition in the HIV-infected child and of recognizing the severity of malnutrition, especially in relation to the provision of ART. Adherence to therapy and resistance to ARVs are discussed. A section on ART in adolescents briefly outlines key issues related to treatment and care for this age group.
WHO recognizes the need to strengthen health systems with a view to maximizing the quality and long-term benefits of ART. Improved access to HIV diagnostic testing for infants and children is necessary to save lives. The inability to diagnose HIV infection as early as possible in infants and children severely limits access to ART and its timely initiation. Reliable access to immunological assays for assessing CD4 levels in children is crucial for guiding the initiation of treatment and for optimizing the maintenance of ART.
These guidelines are intended primarily for use by treatment advisory boards, national AIDS programme managers and other senior policy-makers who are involved in the planning of national and international HIV care strategies for infants and children in resource-limited countries. Elements of the guidelines such as the simplified dosing guidance (Annex E) are also designed for clinical implementation in the field.
Paediatric HIV data and statistics
Coverage of antiretroviral prophylaxis among infants born to mothers living with HIV in low- and middle-income countries by region, 2008
Percentage of pregnant women living with HIV and infants born to them who received antiretrovirals for preventing mother-to-child transmission, 2004-2008
Percentage of children receiving antiretroviral therapy in low- and middle-income countries, 2005-2008
Percentage of children under 18 who have lost one or both parents, in countries with HIV prevalence greater than 1 per cent, 2003-2007
1 Comments
very informative and worthy of reading and doing accordingly.