We considered published material pertinent to the review topic, in addition to relevant publications identified by searching PubMed using the search term “paediatric HIV” or “HIV” in combination with “Africa”, “diagnosis”, “treatment”, “prophylaxis”, “mother-to-child transmission”, “cytotoxic T lymphocyte”, and “antibody”. Reference lists within articles identified by this search strategy were also searched. Review articles and book chapters have been included where appropriate because
SeminarInternational perspectives, progress, and future challenges of paediatric HIV infection
Section snippets
Prevention
The most effective way to address the paediatric HIV pandemic is prevention of mother-to-child transmission. However, most infected infants are born to women who are unaware of their status.15 Voluntary counselling and testing is a prerequisite to enable women to access programmes for prevention of mother-to-child transmission.15 Transmission can be reduced substantially in resource-poor settings, as reviewed elsewhere,16, 17, 18 but only 5–10% of pregnant women have access to such strategies.1
Natural history of paediatric HIV infection
Most paediatric HIV infections are acquired through mother-to-child transmission,33 although infection via contaminated blood products or tissue, unsafe injection, or incision practices, and sexual abuse also takes place.34, 35, 36 In adolescents, horizontal spread through sexual contact and injection drug use are also substantial methods of transmission.33, 37
The overall risk of mother-to-child transmission without interventions is 15–30% in Europe and USA38, 39, 40 but 25–40% in sub-Saharan
Immune control
The immune system can contain HIV, at least temporarily, and, in some instances, long term. CD8+ cytotoxic T lymphocytes (CTL)82, 83, 84 play a central part in this HIV-specific immune response (figure).82, 84, 85, 86, 87 The most direct evidence comes from studies in the simian-immunodeficiency-virus-macaque model, in which anti-CD8 monoclonal antibody infusions showed that CD8+ T cells mediate the decline in acute viraemia in adult infection, and contribute to maintenance of the viral
Management
Identification of HIV-infected children by reliable, affordable techniques is essential to enable early institution of prophylaxis and treatment. The simplest laboratory test, used to diagnose HIV infection in adults, is an antibody test (usually by ELISA). Although this test is suitable for children older than 18 months, up to this time transplacental-maternal antibody persists, and a positive result is therefore diagnostic only of maternal infection. The gold standard for children under 18
Search strategy and selection criteria
References (181)
Children and HIV in Africa: what is next?
Lancet
(2003)- et al.
Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century
Lancet
(2002) Current issues in the prevention of mother-to-child transmission of HIV-1 infection
Trans R Soc Trop Med Hyg
(2006)- et al.
Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study
Lancet
(2007) - et al.
Vaccines to prevent transmission of HIV-1 via breastmilk: scientific and logistic priorities
Lancet
(2006) - et al.
Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections
Lancet
(2004) - et al.
Risk factors for mother-to-child transmission of human immunodeficiency virus-1 infection
Am J Obstet Gynecol
(1995) - et al.
Opportunistic lymphoproliferations associated with Epstein-Barr viral DNA in infants and children with AIDS
Lancet
(1985) - et al.
Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis
Lancet
(2004) - et al.
HIV infection among paediatric in-patients in Blantyre, Malawi
Trans R Soc Trop Med Hyg
(2004)