An update on HIV in children

HIV transmission in childhood occurs almost exclusively from the HIV-infected mother to her child via placenta in utero, during labour and delivery or through the gastrointestinal tract by ingested breast milk. Treatment of infected women achieving an undetectable viral load and postnatal antiretroviral prophylaxis as well as avoidance of breastfeeding reduces risk of vertical transmission to less than 1%. Screening all children of HIV-infected mothers born in settings without measures to prevent vertical transmission for HIV infection is essential as they may have grown up reaching adolescence without any symptoms. Treatment with three antiretroviral drugs of all HIV-infected infants and if CD4 count less than 1000 in 1–3 year olds, CD4 count less than 500 in 3–5 year olds and if CD4 count less than 350 in above 5 year olds is important to reduce morbidity and mortality. Use of a ritonavir-boosted protease inhibitor containing regime in HIV-infected children with anticipated problems with compliance may reduce development of resistance of HIV to antiretroviral drugs.