Priorities for Decreasing Morbidity and Mortality in Children With Advanced HIV Disease
Lisa Frigati1, Moherdran Archary2, Helena Rabie1
1Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town.
Insights
High mortality and illness persist in children starting antiretroviral therapy (ART) for human immunodeficiency virus (HIV), particularly in Africa. Prompt ART initiation is not always beneficial for critically ill children; stabilization is key.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Early mortality and morbidity are significant challenges for children initiating antiretroviral therapy (ART), especially in sub-Saharan Africa.
- Many children present with advanced human immunodeficiency virus (HIV) disease, with tuberculosis, pneumonia, and severe bacterial infections being leading causes of hospitalization.
- While cryptococcal disease is less common in childhood compared to adults, it shows peaks in infancy and adolescence.
Purpose of the Study:
- To review current challenges and interventions for pediatric HIV care.
- To highlight the need for optimized strategies to reduce morbidity and mortality in HIV-infected children.
- To identify research gaps in managing severe infections and immune reconstitution inflammatory syndrome.
Main Methods:
- Literature review and synthesis of existing evidence on pediatric HIV/AIDS management.
- Analysis of common causes of mortality and morbidity in children on ART.
- Evaluation of current intervention strategies, including prophylaxis and ART initiation timing.
Main Results:
- Tuberculosis, pneumonia, and severe bacterial infections are primary causes of hospital admission in HIV-infected children.
- Rapid ART initiation (within 1 week) in severely ill or malnourished children may not be beneficial and could be delayed until stabilization.
- Specific interventions like TB screening and prophylactic isoniazid and cotrimoxazole are recommended.
Conclusions:
- Effective management of pediatric HIV requires targeted interventions, including prophylaxis and careful consideration of ART initiation timing.
- Further research is urgently needed to address severe bacterial infections, pediatric immune reconstitution inflammatory syndrome, and overall morbidity/mortality reduction.
- Optimizing care for HIV-infected children, particularly in resource-limited settings, remains a critical public health priority.
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.
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