Therapeutic management of paediatric Human Immunodeficiency Virus type 1-infection

摘要

More than 2 millions of children worldwide are HIV infected predominantly in developing countries.Recently,in industrialised countries mother-to-child-transmission of HIV has decreased to less than 1-2% due to the use of antiretrovirals during pregnancy.Since 1996,HIV related mortality and morbidity has dramatically decreased due to the use of antiretroviral mul-tifherapies in HIV infected children.Initiation of antiretroviral treatment is based on clinical symptoms,CD4 cells count and plasma HIV RNA viral load.However,immuno-virological criteria may be difficult to understand especially in the infants in whom there is a rare but concerning risk of HIV encephalopathy.Despite the good clinical and immunological results of antiretroviral multitherapies,virological failure may occur.Paediatric pharmacokinetic features and inadequate galenic presentation of drugs could lead to virological failures.However,the use of more potent drugs with more adapted presentation actually reduces this risk of failure.Prospective cohorts of HIV infected children are of importance and can participate in the improvement of the paediatric therapeutic management.