Abstract
Challenges in treatment and prevention remain for pediatric human immunodeficiency virus type 1 (HIV-1) infection as well as increasing concerns for HIV-1 exposed but uninfected infants. Current antiretroviral drugs have excellent potency. However, stigma, adherence barriers, antiretroviral toxicity, and ongoing immune activation threaten the health of children living with HIV-1. Cure awaits a breakthrough in strategies to eradicate the latent HIV-1 reservoir. Perinatal transmission of HIV-1 can be reduced to rates below 1 %, however, operational barriers currently preclude elimination of new infections. HIV-1 exposed, uninfected infants have increased infectious morbidity and mortality compared to their unexposed peers, possibility related to immune deficits. Pediatric HIV-1 is now a chronic illness but treatment fails to reverse all viral pathology. Novel prevention approaches are needed to achieve elimination. Prevention success has revealed excess morbidity and mortality among exposed infants. Innovation in care and prevention remains imperative.
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