Impressive outcome of 'Treat All' HIV infected children globally

Reepa Agrawal
Impressive outcome of 'Treat All' HIV infected children globally 05 Dec, 2018

Recommendations for antiretroviral treatment (ART) in 2016 by World Health Organization (WHO) included treatment of all HIV infected children and pregnant and lactating women irrespective of their CD4 counts. This has proved to be a boon for HIV infected children. According to UNICEF and WHO data released on this World AIDS day, ART coverage for children aged 0 to 14 years has increased from 22 percent in 2010 to 52 percent in 2017 which is more than 50 percent jump. Also perinatal and post-natal infections have decreased by 43 percent since 2010. Prevention of mother-to-child transmission (PMTCT) coverage increased from 61 percent in 2010 to 93 percent in 2017.

Earlier, treatment of HIV infected children and adults was CD4 based. As a priority, ART was initiated in all individuals with severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and individuals with CD4 count =350 cells/mm3. It could also be initiated in all individuals with HIV with a CD4 count >350 cells and =500/mm3 regardless of WHO clinical stage. In children, CD4 count used to differ at various age groups and thus remembering the cut-off CD4 count for starting ART was tedious.

It is interesting to note here that this recommendation of treatment of all has made it very simple for health care workers serving in even remotest of villages to understand whom to treat and whom to not especially when CD4 testing is not available altogether or often. Definitely one needs to monitor the drug side effects but research shows progression to full blown AIDS will decrease. This year the theme for World AIDS Day which was celebrated on 1st of December is 'know your status' which is so apt to remove the taboo associated with the disease and also to initiate treatment if tested positive. Globally 250,000 new HIV infections occured among adolescents 10 -19 years (2 in 3 of these were girls). Also 1.4 million babies were born to mothers living with HIV in 2017 but only half were tested within their first 2 months of life. Along with prophylaxis to prevent vertical transmission administered to mothers, it is also recommended to give ARVs (nevirapine or zidovudine) for first 6 weeks of life to reduce risk of HIV transmission that can occur during labour or breastfeeding. Testing by NAT (nucleic acid test) is suggested at birth for all infants born to HIV positive mothers. Thereafter, rapid diagnostic tests can be done in symptomatic infants till 4 months of age and asymptomatic HIV exposed infants to be tested by 9 months of age and older children after 18 months of age following national strategy testing. Early detection will allow early initiation of ART in those tested positive.

HIV self-testing kits are also now available. Teenage pregnancies are rising in western countries and this strategy may help one to know their status without disclosing the doubt of same to anyone. If positive, confirmatory test and early initiation of ART by health care workers is equally important. The data looks promising but sustaining the same is also a big responsibility on the shoulders of one and all to reach the target to end AIDS by 2030.

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