Update on HIV-1 infection in children

The human immunodeficiency virus (HIV)-1 pandemic has reversed improvements in child survival in sub-Saharan Africa and has adversely influenced infant mortality globally. Compared with HIV-1-infected adults, survival times are shorter for children who acquire the virus perinatally or during infancy. Screening and treatment of HIV-1-infected pregnant women with highly active antiretroviral therapy, obstetric interventions, postnatal prophylaxis with antiretrovirals and alternatives to breastfeeding can collectively prevent mother-to-child transmission (MTCT) of HIV- 1. Furthermore, with appropriate resources, current combination therapy available to suppress HIV-1 infection, have resulted in significant decreases in related morbidity and mortality among infected children. However, regimens can be unpalatable and inconvenient. Management is further compromised by a paucity of pharmacokinetic data and the late development of associated toxicities and poor adherence among adolescents. A global overview of the clinical aspects of HIV infection in children is provided in this paper. Specific UK recommendations to offset MTCT and guidelines on therapy in HIV-1-infected children are presented.