We considered published material pertinent to the review topic, in addition to relevant publications identified by searching PubMed using the search term “paediatric HIV” or “HIV” in combination with “Africa”, “diagnosis”, “treatment”, “prophylaxis”, “mother-to-child transmission”, “cytotoxic T lymphocyte”, and “antibody”. Reference lists within articles identified by this search strategy were also searched. Review articles and book chapters have been included where appropriate because
SeminarInternational perspectives, progress, and future challenges of paediatric HIV infection
Section snippets
Prevention
The most effective way to address the paediatric HIV pandemic is prevention of mother-to-child transmission. However, most infected infants are born to women who are unaware of their status.15 Voluntary counselling and testing is a prerequisite to enable women to access programmes for prevention of mother-to-child transmission.15 Transmission can be reduced substantially in resource-poor settings, as reviewed elsewhere,16, 17, 18 but only 5–10% of pregnant women have access to such strategies.1
Natural history of paediatric HIV infection
Most paediatric HIV infections are acquired through mother-to-child transmission,33 although infection via contaminated blood products or tissue, unsafe injection, or incision practices, and sexual abuse also takes place.34, 35, 36 In adolescents, horizontal spread through sexual contact and injection drug use are also substantial methods of transmission.33, 37
The overall risk of mother-to-child transmission without interventions is 15–30% in Europe and USA38, 39, 40 but 25–40% in sub-Saharan
Immune control
The immune system can contain HIV, at least temporarily, and, in some instances, long term. CD8+ cytotoxic T lymphocytes (CTL)82, 83, 84 play a central part in this HIV-specific immune response (figure).82, 84, 85, 86, 87 The most direct evidence comes from studies in the simian-immunodeficiency-virus-macaque model, in which anti-CD8 monoclonal antibody infusions showed that CD8+ T cells mediate the decline in acute viraemia in adult infection, and contribute to maintenance of the viral
Management
Identification of HIV-infected children by reliable, affordable techniques is essential to enable early institution of prophylaxis and treatment. The simplest laboratory test, used to diagnose HIV infection in adults, is an antibody test (usually by ELISA). Although this test is suitable for children older than 18 months, up to this time transplacental-maternal antibody persists, and a positive result is therefore diagnostic only of maternal infection. The gold standard for children under 18
Search strategy and selection criteria
References (181)
Children and HIV in Africa: what is next?
Lancet
(2003)- et al.
Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century
Lancet
(2002) Current issues in the prevention of mother-to-child transmission of HIV-1 infection
Trans R Soc Trop Med Hyg
(2006)- et al.
Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study
Lancet
(2007) - et al.
Vaccines to prevent transmission of HIV-1 via breastmilk: scientific and logistic priorities
Lancet
(2006) - et al.
Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections
Lancet
(2004) - et al.
Risk factors for mother-to-child transmission of human immunodeficiency virus-1 infection
Am J Obstet Gynecol
(1995) - et al.
Opportunistic lymphoproliferations associated with Epstein-Barr viral DNA in infants and children with AIDS
Lancet
(1985) - et al.
Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis
Lancet
(2004) - et al.
HIV infection among paediatric in-patients in Blantyre, Malawi
Trans R Soc Trop Med Hyg
(2004)
Pneumocystis carinii pneumonia in Zimbabwe
Lancet
Effects of the human immunodeficiency virus on tuberculosis in children
Tuber Lung Dis
Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study
Lancet
Effect of HIV-1 and increasing immunosuppression on malaria parasitaemia and clinical episodes in adults in rural Uganda: a cohort study
Lancet
Immune activation is a dominant factor in the pathogenesis of African AIDS
Immunol Today
A longitudinal assessment of autologous neutralizing antibodies in children perinatally infected with human immunodeficiency virus type 1
Virology
AIDS Epidemic Update, December, 2006
Five year follow up of vertically HIV infected children in a randomised double blind controlled trial of immediate versus deferred zidovudine: the PENTA 1 trial
Arch Dis Child
Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection. Italian Register for HIV Infection in children and the Italian national AIDS registry
JAMA
Decline in mortality, AIDS, and hospital admissions in perinatally HIV-1 infected children in the United Kingdom and Ireland
BMJ
Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV-1
N Engl J Med
18-Month mortality and perinatal exposure to zidovudine in West Africa
AIDS
Predictors of early mortality in a cohort of human immunodeficiency virus type 1-infected African children
Pediatr Infect Dis J
The world health report: make every mother and child count
Treating 3 million by 2005. Making it happen: the WHO strategy
Monitoring the scale-up of antiretroviral therapy programmes: methods to estimate coverage
Bull World Health Organ
Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy
Clin Infect Dis
Unpublished quarterly surveillance tables number 70, 06/1, table 13b
Achievements in Public Health: Reduction in Perinatal Transmission of HIV Infection—United States, 1985–2005
MMWR Morb Mortal Wkly Rep
Evidence behind the WHO guidelines: hospital care for children: what antiretroviral agents and regimens are effective in the prevention of mother-to-child transmission of HIV?
J Trop Pediatr
Strategies to prevent mother-to-child transmission of HIV
Curr Opin Infect Dis
Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants in resource-limited settings: towards universal access. A public health approach
Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis
J Infect Dis
Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial
JAMA
Late postnatal transmission of HIV-1 and associated factors
J Infect Dis
Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival
AIDS
Consensus statement. WHO HIV and infant feeding technical consultation held on behalf of the inter-agency task team (IATT) on prevention of HIV infections in pregnant women, mothers and their infants. Geneva, Oct 25–27, 2006
New data on the prevention of mother-to-child transmission of HIV and their policy implications: conclusions, and implications. WHO Technical Consultation on behalf of the UNFPA/UNICEF/WHO/UNAIDS Inter-Agency Task Team on Mother-to-Child Transmission of HIV. Geneva, October 11–13, 2000. Report No. WHO/RHR/01.28
Alternative modified infant-feeding practices to prevent postnatal transmission of human immunodeficiency virus type 1 through breast milk: past, present, and future
J Hum Lact
Balancing maternal and infant benefits and the consequences of breast-feeding in the developing world during the era of HIV infection
J Infect Dis
Breast-feeding and HIV-1 transmission—how risky for how long?
J Infect Dis
Report on the global AIDS epidemic
Prevention of HIV transmission by blood transfusion in the developing world: achievements and continuing challenges
AIDS
Sexual abuse of children: intersection with the HIV epidemic
Pediatrics
Cases of HIV infection and AIDS in the United States, 2004. HIV/AIDS surveillance report, volume 16
Epidemiology, clinical features, and prognostic factors of paediatric HIV infection
Lancet
Risk factors for mother-to-child transmission of HIV-1
Lancet
A prospective population-based study of HIV perinatal transmission
AIDS
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