Management of HIV-1 Infection in Children

Optimal management of human immunodeficiency virus type 1 (HIV-1)-infected children requires a commitment from the healthcare delivery system, healthcare providers, and affected families and caregivers. When adequate resources are available (as in most industrialised nations), an aggressive approach to early identification of at-risk populations, early diagnosis, and early and aggressive therapy is associated with marked health benefits and cost efficiency. Much of the morbidity and high costs associated with HIV-1 care are related to the management of HIV-1—related complications. Some, but not all, of these could be prevented or lessened by earlier identification of HIV-1 infection and use of antiretroviral therapy for prophylaxis against opportunistic infections. Prevention of any opportunistic infection is always preferable to treatment. The greatest optimism for those caring for HIV-1—infected children has been provided by the success of antiretroviral therapy in preventing mother-to-infant HIV-1 transmission. A goal of reducing perinatal transmission of HIV-1 in industrialised nations from 25% to 2% or less is very reasonable. The recent success in Thailand provides hope that less privileged areas of the world with high burdens of HIV-1 infection might also be capable of benefiting from intervention strategies that will be accessible to them.