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Advances in the prevention and treatment of paediatric HIV infection in the United Kingdom
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  1. M Sharland1,
  2. D M Gibb2,
  3. G Tudor-Williams3
  1. 1Paediatric Infectious Diseases Unit, St George’s Hospital, Blackshaw Road, London SW17 0QT, UK
  2. 2Clinical Trials Unit, Medical Research Council, 222 Euston Road, London NW1 2DA, UK
  3. 3Paediatric Infectious Diseases Unit, St Mary’s Hospital, 6th Floor, QEQM Wing, Praed St, London W2 1NY, UK
  1. Correspondence to:
    Dr M Sharland, Paediatric Infectious Diseases Unit, St George’s Hospital, Blackshaw Road, London SW17 0QT, UK;
    msharlan{at}sghms.ac.uk

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A summary of recent developments

In the five years since our last review there have been considerable advances, both in the prevention of mother to child transmission (MTCT) of HIV, and in the treatment of HIV infected children with highly active antiretroviral therapy (HAART).1 There are now over 600 children living with HIV in the UK, the majority of whom were born to mothers who acquired HIV in Africa.2 Currently, about two thirds live in London, but this may change if refugees continue to be dispersed to other parts of the country. Antenatal testing for HIV has been shown to be cost effective throughout the UK.3 However, although uptake of testing has increased in London, rates of detection of previously undiagnosed women during pregnancy are about 60% outside London.2 HIV infected babies are still presenting seriously ill and dying with Pneumocystis carinii pneumonia (PCP) in the first months of life.4 In 1999 the Department of Health (DoH) set targets that by the end of 2002, all UK health authorities should increase uptake of antenatal HIV testing to 90%, with the aim that 80% of HIV infected pregnant women nationally would be identified and offered treatment.5 These targets will only be met if testing rates are increased outside London.6 Paediatricians throughout the UK need to be familiar with how MTCT of HIV is prevented, and how to manage children born to HIV infected mothers. This paper summarises the recent developments in prevention and management of HIV infected children.

MOTHER TO CHILD TRANSMISSION OF HIV INFECTION

The rate of MTCT prior to the advent of interventions in Europe and USA was around 15–20%, compared with about 30% in Africa. Most of this difference is a result of breast feeding, which approximately doubles the transmission rate. In non-breast feeding populations, around two thirds …

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