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Medical management of AIDS in children
  1. A Riordan

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    Edited by William T Shearer, I Celine Hanson. Saunders, 2003, £33.99 (hardcover), pp 434. ISBN 0-7216-8284-7

    Where would you get advice on how to manage a child with HIV? From a textbook like this, from the internet, or would you phone-a-friend? Paediatricians in the UK are increasingly likely to see children infected with, or affected by, HIV. Reasons for this include an increasing number of children with HIV and antenatal screening for HIV, which is identifying increasing numbers of infants at risk of mother to child infection. Most of these children will live in the London area, but 25% are now living in other parts of the UK. Paediatricians thus need information to help them manage these children. This book will provide some useful background information on HIV and about its specific complications. However it may be less valuable in managing children presenting acutely to hospital.

    The three commonest reasons for paediatricians calling me for advice about HIV are: initial diagnosis and treatment; indications for antiretroviral therapy; and management of infants born to HIV positive mothers.

    Diagnosis and initial treatment

    This book contains little information about the issues involved in testing children for HIV, such as consent and confidentiality. These are probably outside the scope of this book, but essential for paediatricians to understand. These issues are well covered by a document on the Children’s HIV Association of UK and Ireland (CHIVA) website (www.bhiva.org/chiva).

    Children with HIV may present with a variety of other infections. The chapter on infectious complications of HIV covers many of these. However, again the information on managing children with HIV with fever, respiratory illness, or diarrhoea on the CHIVA website will be of more immediate use to paediatricians.

    Antiretrovirals

    When to start antiretrovirals and what drugs to start remains controversial. The increasing number of drugs available will make any textbook out of date, almost as soon as it is published. This is probably the case here where newer agents, like tenofovir, are not mentioned. This book also reflects the American view that almost all children with HIV should be on anti-retroviral treatment. The European view of more selective treatment and more up to date information on the drugs available is available from the Paediatric European Network for Treatment of AIDS (PENTA), available at www.ctu.mrc.ac.uk/penta/ or accessed via the CHIVA website.

    Infants born to HIV positive women

    The book does have a good review of the history and methods of preventing mother to child transmission of HIV. This provides excellent background to this topic. However more practical information for managing these babies is provided in the British HIV Association (BHIVA) pregnancy guidelines, available at www.BHIVA.org.

    I found the chapters on HIV in the central nervous system and gastrointestinal system very useful. I have already shared these with colleagues in child development centres and dieticians. Other organ specialists and members of the multidisciplinary team looking after children with HIV, would find other specific chapters helpful. The chapter on palliative care was particularly moving, encouraging those in this field to have humility and perseverance.

    My main criticisms of the book were that it was too focussed on practice in the United States (not surprising when all the authors work there) and missed some recent developments. If a second edition is planned I hope it will include reference to the landmark HIV Paediatric Prognostic Markers Collaborative Study,1 recognise that the organism that causes PCP is now named Pneumocystis jiroveci (not P carinii), and have some authors from outside the USA.

    I would recommend that this book is available in every paediatric department who might see children with HIV. However it would be even more important for these units to have access to the guidelines on the CHIVA website and to have access to an expert in paediatric HIV. The establishment of managed clinical networks for paediatric HIV across the UK, as has already occurred in London, should improve this.

    Edited by William T Shearer, I Celine Hanson. Saunders, 2003, £33.99 (hardcover), pp 434. ISBN 0-7216-8284-7

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