Regular review: HIV infection in children

摘要

HIV has transformed paediatric practice in developing countries. A specialty that once dealt mainly with acute illnesses is now consumed, in many settings, with managing chronically ill and dying children. Last year, 600 000 children were newly infected with HIV, over 90% in sub-Saharan Africa and almost all having acquired the virus by vertical transmission, from mother to child. The statistics do not adequately portray the suffering and disrupted lives of the most vulnerable of the world's population. The HIV pandemic has eroded many of the hard earned gains made in reducing infant and child mortality. The United Nations Program on HIV and AIDS (UNAIDS) recently reported that, by 2010, a doubling in child mortality is expected in regions with a high prevalence of infection. Globally, the number of orphans from AIDS will increase from the current 13.2 million to 44 million by 2010. Already, one child in 10 is an orphan in some countries. Finding appropriate responses to this crisis must rank as the single most important global challenge to child health in the next decade. This article reviews advances in preventing vertical transmission, antiretroviral treatment, and vaccine development, and we attempt to predict future developments.