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Primary care for HIV-exposed and infected children: translating progress into practice
1Pediatric HIV/AIDS Program, University of Maryland School of Medicine, Baltimore, USA.
Insights
Pediatric human immunodeficiency virus (HIV) management guidelines have advanced, emphasizing specialist collaboration for optimal care. Early diagnosis and combination antiretroviral therapy significantly improve outcomes for HIV-infected children.
Area of Science:
- Pediatric Infectious Diseases
- Public Health
Background:
- Guidelines for diagnosing and managing pediatric HIV infection have recently been updated.
- Primary care practitioners are crucial for identifying at-risk infants and children.
- Collaboration with pediatric HIV specialists ensures state-of-the-art care for HIV-exposed and HIV-infected children.
Purpose of the Study:
- To summarize recent advances in pediatric HIV diagnosis and management.
- To highlight the collaborative roles of primary care and specialist teams.
- To discuss the impact of combination antiretroviral therapy and psychosocial factors.
Main Methods:
- Review of recent advances in pediatric HIV guidelines.
- Discussion of diagnostic strategies and therapeutic interventions.
- Exploration of psychosocial aspects and collaborative care models.
Main Results:
- Perinatal transmission rates have decreased to 3-4% with interventions like zidovudine and combination antiretroviral therapy.
- Diagnosis in perinatally infected infants is possible by 6 months of age.
- Combination antiretroviral therapy is effective but complex; psychosocial issues and disclosure are key clinical considerations.
Conclusions:
- Collaborative care between families, primary care, and pediatric HIV specialists is essential for managing pediatric HIV.
- Ongoing medical and psychosocial support is vital as children grow.
- Disclosure of HIV status is an important aspect of care for children and families.
Abstract:
Recent advances have changed the guidelines for diagnosing and managing pediatric human immunodeficiency virus (HIV) infection. HIV-exposed and HIV-infected children should be evaluated by, or in consultation with, pediatric HIV specialists. Primary care practitioners play a vital role in identification of infants and children at risk for HIV infection and can work collaboratively with pediatric HIV specialists to provide state-of-the-art care. With the use of perinatal zidovudine, perinatal transmission rates have been reduced to 3% to 4%, and they may be reduced even further by the use of combination antiretroviral therapy during pregnancy, viral load monitoring, and obstetric interventions. Diagnosis of HIV infection can be determined in all perinatally infected infants by 6 months of age. Combination antiretroviral therapy is the standard of care for HIV-infected children. It has become increasingly effective, but complex. Families living with HIV are affected by a number of psychosocial issues. Disclosure of HIV diagnosis to a child is an important clinical issue. As HIV-infected children grow older, medical and psychosocial issues may impact school performance. The plan of care to address specific needs of HIV-infected children should be a collaborative effort between the children, their families, the primary care team, and the multidisciplinary pediatric HIV specialty team.