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Sepsis predisposition in children with human immunodeficiency virus
1Paediatric Intensive Care Unit, School of Child and Adolescent Health, University of Cape Town, South Africa.
Summary
Highly active antiretroviral therapy (HAART) has improved outcomes for children with human immunodeficiency virus (HIV), reducing sepsis risk. However, disparities in HAART access mean sepsis susceptibility and mortality remain significant concerns, especially in developing countries.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Public Health
Background:
- Human immunodeficiency virus (HIV) infection in children presents unique challenges, particularly concerning sepsis susceptibility.
- The advent of highly active antiretroviral therapy (HAART) has significantly altered the landscape of pediatric HIV care.
- Access to and response to HAART vary globally, leading to divergent clinical outcomes.
Purpose of the Study:
- To review the predisposition to sepsis in children infected with HIV during the HAART era.
- To understand how HAART influences sepsis risk, morbidity, and mortality in pediatric HIV populations.
- To highlight disparities in care and outcomes based on HAART access.
Main Methods:
- Literature review and expert analysis.
- Synthesis of existing data on pediatric HIV and sepsis.
- Examination of outcomes in different geographical and treatment access settings.
Main Results:
- HAART has led to clinical stability, reduced viral loads, and improved immune function (CD4 counts) in HIV-infected children in industrialized regions.
- Sepsis risk, acquired immunodeficiency syndrome progression, and early mortality have decreased significantly in children with access to HAART.
- In contrast, children in developing countries with limited HAART access experience a natural disease progression, with high mortality rates before age 3.
- HIV-infected children, even on HAART, may have a higher burden of sepsis and potentially greater case fatality rates for non-opportunistic infections compared to non-HIV-infected children.
- Data on the impact of initiating HAART during acute sepsis are lacking.
Conclusions:
- Pediatric HIV infection is heterogeneous in the HAART era, with outcomes varying by disease stage and HAART access.
- Sepsis susceptibility, morbidity, and mortality are influenced by treatment access and individual response to HAART.
- Consideration of these factors is crucial for clinical trial design and patient stratification in pediatric HIV research.