The Indian Pediatric HIV Epidemic: A Systematic Review

Abstract

Despite an estimated 70,000 Indian children living with HIV infection, little is known about India's pediatric HIV epidemic. Generalizations about epidemiology, natural history, and treatment outcomes from other resource-limited settings (RLS) may be inaccurate for several biologic and social reasons. A review of the Indian literature is needed to optimize country-specific HIV management and examine these generalizations. MEDLINE and EMBASE were searched for articles published in English by November 2007 on HIV-infected, Indian children (0-18 years) that detailed epidemiology, natural history, or treatment. Articles with original, extractable data were selected and summarized using descriptive statistics. Of 370 citations, 58 studies were included in this review (median study size 24 children). Significant heterogeneity was noted among the studies. HIV infection was reported nearly twice as often in males (male/female ratio 1.9) and diagnosed earlier (4.7 years) than in other RLS. Over 2% of hospitalized children were reported to be HIV-infected. The reported mortality among HIV-infected newborns of 22% at 18 months was lower than other RLS. Improved anthropometrics were the only consistently reported and comparable benefit of short-term HAART to other RLS. Review of the Indian literature yielded potentially unique epidemiology and natural history compared to other RLS. However, important questions about the accuracy and representativeness of the Indian data limit its generalizability and comparability. Targeted interventions to curb India's pediatric HIV epidemic require urgent clarification of these findings. If such differences truly exist, management guidelines should be tailored accordingly.

Growth Patterns of HIV Infected Indian Children in Response to ART: A Clinic Based Cohort Study

“…A high prevalence of stunting and underweight among CLHIV found in the index study is consistent with other studies from India [14][15][16]. The severity of malnutrition in the index study exceeded the level of malnutrition seen in the State of Maharashtra (National Family Health Survey 2005-6 reported median WAZ and HAZ of −1.6 and −1.8, respectively, among children less than 5-y-old) [21].…”

“…Delayed diagnosis and late linkage to care are common among CLHIV. A high prevalence of stunting and underweight has been reported in these children when they reach care [14]. Although HIV disease progression in India is considered to be similar to other settings with limited resources, growth response after ART initiation may differ mainly due to country-specific differences in baseline nutritional status and co-morbidities.…”

High Rates of All-cause and Gastroenteritis-related Hospitalization Morbidity and Mortality among HIV-exposed Indian Infants

“…Examining hospitalization morbidity among HIV-infected and HIV-exposed, uninfected Indian infants is necessary to determine country-specific feasible and sustainable targets to further reduce morbidity and mortality. Therefore, we used data from Six Week Extended-Dose Nevirapine (SWEN), a recently completed NIH randomized clinical trial of prevention of mother-to-child HIV transmission (PMTCT) among breastfed infants in Pune, India [11] to investigate all-cause hospitalization rates among HIV-infected and HIV-exposed, uninfected infants. We also examined cause-specific hospitalization rates, as well as hospitalization reasons, and risk factors for hospitalization among HIV-infected and HIV-exposed, uninfected infants.…”

High Rates of Colonization with Drug Resistant Hemophilus Influenzae Type B and Streptococccus Pneumoniae in Unvaccinated HIV Infected Children from West Bengal

“…Each year, 21,000 Indian children are newly infected [9,10]. In India, vaccines which remain an important tool in the management of children with HIVare under different programs and not included under the umbrella of HIV care [11].…”