Abstract
Early mortality and morbidity remain high in children initiating antiretroviral therapy (ART), especially in sub-Saharan Africa. Many children still present with advanced human immunodeficiency virus (HIV) disease. Tuberculosis, pneumonia, and severe bacterial infections are the main causes of hospital admission in HIV-infected children. In contrast to adults with advanced HIV disease, cryptococcal disease is not common in childhood, although there is a peak in infancy and adolescence. Interventions such as TB screening in symptomatic children, and isoniazid and cotrimoxazole prophylaxis should be implemented. There is evidence suggesting that rapid initiation (within 1 week) of ART in children with severe malnutrition or those with advanced HIV disease admitted to hospital is not beneficial and should be delayed until their condition has been stabilized. Research informing the prevention of severe bacterial infections, the management of pediatric immune reconstitution inflammatory syndrome, and other potential strategies to decrease morbidity and mortality in HIV-infected children are urgently needed.
Highlights
Mortality in human immunodeficiency virus (HIV)–infected children with advanced disease initiating antiretroviral therapy (ART) is high, in sub-Saharan Africa [1]
There is some evidence that high mortality among children with advanced HIV disease is not limited to low-resource settings: a recent study examining trends in mortality and AIDS-defining events after ART initiation among children and adolescents with perinatal HIV in Europe and Thailand found that, of 94 deaths, 43 (46%) occurred within the first 6 months and 79 of the 174 (45%) first AIDS-defining events occurred within 6 months after ART initiation [5]
The World Health Organization (WHO) recently released guidelines focusing on adults and children with advanced HIV disease with the aim of reducing mortality in this population [8]
Summary
Priorities for Decreasing Morbidity and Mortality in Children With Advanced HIV Disease. Mortality in human immunodeficiency virus (HIV)–infected children with advanced disease initiating antiretroviral therapy (ART) is high, in sub-Saharan Africa [1]. The World Health Organization (WHO) recently released guidelines focusing on adults and children with advanced HIV disease with the aim of reducing mortality in this population [8] These guidelines focus on providing an enhanced package of prophylactic, diagnostic, and therapeutic interventions for those initiating ART with advanced disease, as well as providing recommendations on rapid initiation of ART. This article highlights the differences between the guideline recommendations for adults and children with regard to the definition of advanced disease in children
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