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3 Treatment of HIV-Infected Children NIAID investigators are defining the best treatments for pediatric patients. Currently there are 16 drug products approved by the FDA for the treatment of adult HIV infection. Through major contributions by the Pediatric ACTG, 10 antiretroviral agents have pediatric label information, including 3 protease inhibitors.28 While the basic principles that guide treatment of pediatric HIV infection are the same as for any HIV-infected person, there are a number of unique scientific and medical concerns that are important to consider in the treatment of children with HIV infection. These range from differences from adults in age-related issues such as CD4 lymphocyte counts and drug metabolism to requirements for special formulations and treatment regimens that are appropriate for infants through adolescents. As in adults, treatment of HIV-infected children today is a complex task of using potent combinations of antiretroviral agents to maximally suppress viral replication. Researchers supported by NIAID are focusing not only on the development of new antiretroviral products but also on the critical question of how to best use the treatments that are currently available. Treatment strategy questions designed to identify what the best initial therapy is, when failing regimens should be switched and strategies for how to address the antiretroviral needs of children with advanced disease are examples. Long-term assessment of these children is also a high priority to assess sustained antiretroviral benefits as well as to monitor for potential adverse consequences of treatment. Problems of Families A mother and child with HIV usually are not the only family members with the disease. Often, the mother's sexual partner is infected, and other children in the family may be infected as well. Frequently, a parent with AIDS does not survive to care for his or her HIV-infected child. In the countries hardest hit by the AIDS epidemic, some 8.2 million children under 15 around the world have been orphaned by AIDS - 90 percent of them in sub-Saharan Africa alone.31 The rate is expected to increase. One in three of these orphans is under age five.32 Communities and extended families are struggling with and often overwhelmed by the vast number of AIDS orphans. Many orphans and other children from families devastated by AIDS face multiple risks, such as forced relocation, violence, living on the streets, drug use, and even commercial sex. Other children suffer because sex education and services are not available to them or do not communicate effectively to them. Living in a country undergoing political turmoil or where fathers migrate for work can also raise the risk of a child becoming HIV-infected. In the U.S., most children living with HIV/AIDS live in inner cities, where poverty, illicit drug use, poor housing and limited access to and use of medical care and social services add to the challenges of HIV disease. One encouraging note is that, according to UNAIDS, where information, training, and services to help prevent HIV infection are made available and affordable to young people, they are more likely to make use of them than their elders are.33 Management of the complex medical and social problems of families affected by HIV requires a multidisciplinary case management team, integrating medical, social, mental health and educational services. NIAID provides special funding to many of its clinical research sites to provide for services, such as transportation, day care, and the expertise of social workers, crucial to families devastated by HIV. References 1.
Connor, E. et al. 1994. Reduction of maternal-infant transmission
of human immunodeficiency virus type 1 with zidovudine treatment.
N Engl J Med 311:1173-80. Reprinted
with permission from NIAID is a component of the National Institutes of Health (NIH). NIAID conducts and supports research to prevent, diagnose and treat illnesses such as HIV disease and other sexually transmitted diseases, tuberculosis, malaria, and other infectious diseases as well as asthma and allergies.
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