Management of HIV-infected children in Africa: progress and challenges
- Ruth M Bland1,2
- 1Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu‑Natal, South Africa
- 2College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Correspondence to Dr Ruth M Bland, Africa Centre for Health and Population Studies, University of KwaZulu-Natal, PO Box 198, Mtubatuba, KwaZulu-Natal 3935, South Africa;
- Accepted 8 April 2011
- Published Online First 11 May 2011
Over the past three decades HIV has caused significant morbidity and mortality among children, with sub-Saharan Africa bearing the brunt of the epidemic.1 Of the estimated 33 million people living with HIV, 2.5 million are children under the age of 15 years, of whom 2.3 million live in sub-Saharan Africa.2 Substantial progress has been made over the past decade in reducing the number of children infected with HIV as well as paediatric HIV-related deaths. Increasing availability of effective drug regimens to reduce mother-to-child transmission of HIV (the main route of HIV infection in children) has led to a global decline in new paediatric infections from 500 000 in 2001 to an estimated 370 000 in 2009.1 Fewer infected children and increased access to HIV treatment for those who are infected has resulted in a reduction in the number of HIV related deaths from 320 000 in 2004 to 260 000 in 2009.1 In many resource-poor settings, HIV has now become a chronic condition as opposed to a fatal disease.3,–,6 However, significant challenges remain, and need to be addressed, if Millennium Development Goal 4 to reduce under-5 mortality by two-thirds between 1990 and 2015, is to be met (box 1).
Box 1 Mother-to-child transmission of HIV
▶ Most children are infected with HIV via mother-to-child transmission (vertical transmission). In 2009 approximately 1000 new paediatric infections occurred worldwide each day.1 Transmission can occur in utero, intrapartum or through breastfeeding. Without any interventions in breastfeeding populations, approximately one in three infants will become infected. In resource-rich settings, mother-to-child transmission of HIV has almost been eliminated (<2% of exposed infants), with the widespread use of HAART, caesarean sections and avoidance of breastfeeding.
“No child should be born with HIV; no child should be an orphan because of HIV; no …