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Management of vertically HIV-infected children in Europe
1Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, UK.
Insights
Pediatric HIV management balances treatment benefits against side effects. Most children remain asymptomatic, highlighting the need for careful antiretroviral therapy (ART) decisions in managing vertically HIV-infected children.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Public Health
Background:
- Vertically HIV-infected children require tailored therapeutic management strategies.
- Balancing the benefits of antiretroviral therapy (ART) against potential side effects and adherence challenges is crucial.
- Most children with HIV remain asymptomatic for extended periods, influencing treatment decisions.
Purpose of the Study:
- To delineate policies for managing vertically HIV-infected children.
- To compare stated management policies with actual clinical practice.
- To analyze treatment patterns in a cohort of HIV-infected children.
Main Methods:
- A postal questionnaire survey of clinicians in European Collaborative Study (ECS) pediatric centers.
- Analysis of prospective data on treatment and clinical status of infected children (1999-2001).
- Comparison of reported year 2000 policies with observed clinical practice.
Main Results:
- Treatment policies varied: 3 centers initiated ART routinely in infants, while 7 delayed until criteria were met.
- Disease progression, adherence, and side effects influenced treatment modifications.
- Clinical practice did not consistently align with stated policies.
- For 84 children over 5 years, 69% of person-years were spent without ART, and 72% without symptoms.
Conclusions:
- Effective management of pediatric HIV necessitates balancing disease prevention with minimizing treatment-related issues.
- The high proportion of asymptomatic periods in infected children informs therapeutic strategies.
- Emerging European consensus guidelines aim to standardize and improve the management of pediatric HIV.
Aim:
To describe policies for the therapeutic management of vertically HIV-infected children, and to compare these with practice, using children enrolled in a cohort study in the same setting.
Methods:
A postal questionnaire survey of clinicians in the paediatric centres of the European Collaborative Study (ECS) was used. Prospective data collected within the ECS on the treatment and clinical status of infected children seen in these centres in 1999-2001 were analysed and compared with the year 2000 policies reported.
Results:
In 3 of the 10 centres, the policy was routinely to administer antiretroviral therapy (ART) to infants upon confirmation of infection, and in 7 centres initiation of therapy was delayed until specific clinical, virological and immunological criteria were reached. Evidence of disease progression was a reason for treatment modification in all centres; other considerations included adherence problems and side effects. However, practice did not always match policy. For the 84 children with at least 5 y of follow-up (73 treated and 11 untreated), overall, 69% of the 420 person-years lived were spent without treatment, and 72% without any HIV-related symptoms. Untreated children were without symptoms for 94% of these 5 y, whereas treated children spent nearly a third of their time with mild or moderately severe symptoms.
Conclusions:
Therapeutic management of paediatric HIV disease requires a balance between preventing disease progression and minimizing adherence problems and side effects. This is important, as most infected children are without symptoms most of the time. Recent European consensus guidelines for the treatment of infected children will facilitate management.