Pediatric HIV: Progress on Prevention, Treatment, and Cure

Abstract

Purpose of review This review provides an update on current developments with prevention, treatment and cure strategies in the field of pediatric HIV. Recent findings/Summary There has been tremendous progress in the prevention and treatment of pediatric HIV infection. With new strategies for prevention of mother-to-child transmission, we are growing ever closer towards elimination of pediatric HIV, though challenges with retention of pregnant woman and their HIV-exposed infants remain. Ongoing vigilance regarding the potential hazards of in utero ART exposure to infants continues with no significant alarms yet identified. Though cure has not been achieved, evidence of the impact of early treatment on reducing HIV-1 reservoir size with subsequent prolonged remission has enlivened efforts to rapidly identify and treat HIV-infected newborns. There is an increasing array of treatment options for pediatric patients and reassuring evidence regarding long-term complications of ART. Unfortunately, despite evidence suggesting the benefit of early treatment, timely identification and treatment of children remains a challenge. Better strategies for effective case-finding and engagement in care are urgently needed in addition to an improved understanding of how to retain HIV-positive children and adolescents on treatment. However, further emboldened by recent international commitments and robust global support, the future is hopeful.

Uptake and performance of prevention of mother‐to‐child transmission and early infant diagnosis in pregnant HIV‐infected women and their exposed infants at seven health centres in Addis Ababa, Ethiopia

“…The immediate initiation or ART at the time of HIV diagnosis, as recommended within the Option B+ procedures, is controversially debated as there is concern on sustained treatment adherence. In fact, defaulting from treatment has been reported to be higher in women starting on Option B+ as than in those who were already on ART based on clinical and immunological criteria . In our analysis, we did not observe differences in self‐reported treatment adherence between women who immediately started ART and those with delayed ART initiation, or between women who started ART during pregnancy and those who were already on ART prior to pregnancy.…”

Retention in care and reasons for discontinuation of lifelong antiretroviral therapy in a cohort of Cameroonian pregnant and breastfeeding HIV‐positive women initiating ‘Option B+’ in the South West Region

“…This implies that these women were possibly not adequately prepared to start lifelong ART. Treatment preparedness and readiness to start and commit to adhere to lifelong ART are critical for treatment success , and LTFU was reported to be higher in women starting on Option B+ than in those who were already on ART before pregnancy . In Malawi, a 17% LTFU at 6 months after ART initiation was observed with a better retention in care in women who did not start ART on the same day of HIV diagnosis or who received focused counselling .…”

Enhancing an HIV index case testing passive referral model through a behavioural skills‐building training for healthcare providers: a pre‐/post‐assessment in Mangochi District, Malawi

“…In Malawi, in spite of a generalized HIV epidemic and a mature HIV response, approximately 250,000 HIV‐positive adults remain unaware that they are living with HIV . This makes them unable to access antiretroviral therapy (ART) which has proven benefits for the health of the individual and prevention of horizontal and vertical transmission .…”