Growing Up with HIV/AIDS

by

Stephanie Shiau, Lindsey Reif

• LAST MODIFIED: 27 February 2019
• DOI: 10.1093/obo/9780199791231-0213

Introduction

Largely due to increased success in prevention of mother-to-child transmission, new HIV infections among children globally have declined by 47 percent since 2010, from 300,000 in 2010 to 160,000 in 2016. However, the epidemic continues. In 2016 2.1 million children under fifteen years old were estimated to be living with HIV globally, with 85 percent living in sub-Saharan Africa. Without access to HIV care and antiretroviral therapy (ART), infants and younger children living with HIV are at high risk for mortality, with a mortality rate of about 30 percent by the first year of life and 50 percent by their second year. Therefore, prompt diagnosis and adherence to effective ART is critical. Early infant diagnosis is becoming more widely available globally, allowing for earlier identification of infection close to birth and opportunities to start treatment early in infants and the potential for cure strategies. With effective treatment, pediatric HIV infection has been transformed from a fatal disease to a lifelong chronic disease. Much of pediatric HIV care focuses on co-morbidities related to long-term HIV infection and its treatment. In addition, children living with HIV require close monitoring as they age into adolescence, a high-risk period when they navigate mental, physical, and emotional development. As adolescents become independent from parents or guardians and face choices regarding relationships, sexual behavior, and alcohol and drug use, they are at high risk for poor adherence to ART.

Diagnosis

Children who are vertically infected with HIV acquire HIV intrauterine, intrapartum, or via breastfeeding. In adults and older children, HIV is usually diagnosed with HIV antibody tests. However, Moodley, et al. 1995 and Chantry, et al. 1995 showed that maternal HIV antibody transmitted via the placenta may persist in children up to eighteen months of age. Therefore, in children HIV infection should be confirmed with virological testing using HIV nucleic acid testing (NAT) technologies. Bryson, et al. 1992 proposed definitions for in utero and intrapartum transmission of HIV detected via polymerase chain reaction (PCR). Access to early infant diagnosis (EID) has improved but Chatterjee, et al. 2011 showed there are still delays in starting infants on ART in a timely matter. Penazzato, et al. 2014 and Ciaranello, et al. 2011 reported on how point-of-care assays and adding NAT at birth can improve HIV diagnosis and early treatment in HIV-infected infants. Mallampati, et al. 2017 reviewed the diagnostic accuracy of virological testing at birth and the performance of virological testing on dried blood spots at six weeks in infants exposed to HIV and its treatment. Technau, et al. 2017 evaluated point-of-care testing in an experience in the field.

• Bryson, Y. J., K. Luzuriaga, J. L. Sullivan, and D. W. Wara. “Proposed Definitions for In Utero Versus Intrapartum Transmission of HIV-1.” The New England Journal of Medicine 327.17 (1992): 1246–1247.

  DOI: 10.1056/NEJM199210223271718

  This letter to the editor discusses the proposed definition for in utero versus intrapartum transmission of HIV in infants.

• Chantry, C. J., E. R. Cooper, S. I. Pelton, C. Zorilla, G V. Hillyer, and C. Diaz. “Seroreversion in Human Immunodeficiency Virus-Exposed but Uninfected Infants.” The Pediatric Infectious Disease Journal 14.5 (1995): 382–387.

  DOI: 10.1097/00006454-199505000-00009

  This study describes seroreversion in a cohort of HIV-exposed but uninfected infants.

• Chatterjee, A., S. Tripathi, R. Gass, et al. “Implementing Services for Early Infant Diagnosis (EID) of HIV: A Comparative Descriptive Analysis of National Programs in Four Countries.” BMC Public Health 11 (2011): 553.

  DOI: 10.1186/1471-2458-11-553

  This review article evaluated the testing-to-treatment cascade in four countries: Cambodia, Senegal, Uganda, and Namibia.

• Ciaranello, A. L., J. E. Park, L. Ramirez-Avila, K. A. Freedberg, R. P. Walensky, and V. Leroy. “Early Infant HIV-1 Diagnosis Programs in Resource-Limited Settings: Opportunities for Improved Outcomes and More Cost Effective Interventions.” BMC Medicine 9 (2011): 59.

  DOI: 10.1186/1741-7015-9-59

  This literature review discusses the benefits and challenges of implementing early infant diagnosis services in resource-limited settings.

• Mallampati, D., N. Ford, A. Hannaford, N. Sugandhi, and M. Penazzato. “Performance of Virological Testing for Early Infant Diagnosis: A Systematic Review.” Journal of Acquired Immune Deficiency Syndromes 75.3 (2017): 308–314.

  DOI: 10.1097/QAI.0000000000001387

  This systematic review assessed the diagnostic accuracy of virological testing at birth as well as the performance of virological testing on dried blood spots at six weeks in infants exposed to HIV and antiretrovirals.

• Moodley, D., R. A. Bobat, A. Coutsoudis, and H M. Coovadia. “Predicting Perinatal Human Immunodeficiency Virus Infection by Antibody Patterns.” The Pediatric Infectious Disease Journal 14.10 (1995): 850–852.

  DOI: 10.1097/00006454-199510000-00006

  This study evaluates antibody decay rates in infected and uninfected children.

• Penazzato, M., P. Revill, A. J. Prendergast, et al. “Early Infant Diagnosis of HIV Infection in Low-Income and Middle-Income Countries: Does One Size Fit All?” The Lancet Infectious Diseases 14.7 (2014): 650–655.

  DOI: 10.1016/S1473-3099(13)70262-7

  This paper discussed various strategies to deliver early infant diagnosis services.

• Technau, K. G., L. Kuhn, A. Coovadia, P. M. Murnane, and G. Sherman. “Xpert HIV-1 Point-of-Care Test for Neonatal Diagnosis of HIV in the Birth Testing Programme of a Maternity Hospital: A Field Evaluation Study.” The Lancet HIV 4.10 (2017): e442–e448.

  DOI: 10.1016/S2352-3018(17)30097-8

  This field evaluation study of neonatal HIV diagnosis in South Africa compared the results of point-of-care technology to laboratory-based testing.