The changing epidemiology of the global paediatric HIV epidemic: keeping track of perinatally HIV‐infected adolescents

Abstract

The global paediatric HIV epidemic is shifting into a new phase as children on antiretroviral therapy (ART) move into adolescence and adulthood, and face new challenges of living with HIV. UNAIDS reports that 3.4 million children aged below 15 years and 2 million adolescents aged between 10 and 19 years have HIV. Although the vast majority of children were perinatally infected, older children are combined with behaviourally infected adolescents and youth in global reporting, making it difficult to keep track of their outcomes. Perinatally HIV-infected adolescents (PHIVA) are a highly unique patient sub-population, having been infected before development of their immune systems, been subject to suboptimal ART options and formulations, and now face transition from complete dependence on adult caregivers to becoming their own caregivers. As we are unable to track long-term complications and survival of PHIVA through national and global reporting systems, local and regional cohorts are the main sources for surveillance and research among PHIVA. This global review will utilize those data to highlight the epidemiology of PHIVA infection, treatment challenges and chronic disease risks. Unless mechanisms are created to count and separate out PHIVA outcomes, we will have few opportunities to characterize the negative consequences of life-long HIV infection in order to find ways to prevent them.

HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub‐Saharan African countries

“…Negotiating these milestones can be both rewarding and challenging for all adolescents; for adolescents living with HIV (ALHIV), this transition is exacerbated by a chronic, stigmatized and sexually transmissible disease [3]. …”

Safety-engineered intravenous catheter utilization among Canadian pediatric anesthesiologists

“…30 Also, children are living longer with perinatal acquired human immunodeficiency virus (HIV), making HIV infection an ever-present risk. 31,32 Lack of available SEICs or reluctance to use them may affect the health and safety of trainees, co-workers, and 34 which are responsible for an estimated 10% of nosocomial infections, 35 and are clinically acceptable for delivering high flows. 36 Respondents offered many suggestions for improving the design of SEICs for pediatric practise.…”

Caring for ‘underground’ kids: qualitative interviews with clinicians about key issues for young people growing up with perinatally acquired HIV in Australia

“…Perinatally infected young people are also seen as different within HIV medicine itself. Unlike other people with HIV, they were infected before the development of their immune system and many have been subject to suboptimal ARV options, especially during younger years (Sohn & Hazra, 2013). The metabolic, neurodevelopmental and multi-organ effects of this are only now starting to emerge (Mofenson & Cotton, 2013).…”

“…The survival of HIV-positive children into adolescence and beyond in high-resource countries, and increasingly in low-resource countries, represents one of the great successes in the 'battle against the disease that has claimed the lives of millions' (Agwu & Fairlie, 2013, p. 1). But this success, researchers argue, has in turn brought with it new challenges as this population is starting to reveal some of the unknown and wide-ranging ramifications of long-term HIV infection and antiretroviral (ARV) therapy, which clinicians must identify and manage (Mofenson & Cotton, 2013;Sohn & Hazra, 2013;Wiener, Battles, & Wood, 2007).…”