The 'pulmonary diseases spectrum' in HIV infected children
1Department of Pediatrics, KB Bhabha Hospital, Bandra West, D-9, Park Bay, 295, Vidyanagari Road, Kalina, Santacruz [E], Mumbai, 400098, Maharashtra, India.
Insights
Despite advances in HIV care, pulmonary diseases remain a critical threat to children. Early Highly Active Antiretroviral Therapy (HAART) and prophylaxis significantly reduce respiratory infections in HIV-affected children.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Research
- Respiratory Medicine
Background:
- Pulmonary diseases are a leading cause of illness and death in children with HIV, despite overall treatment advances.
- Effective prevention of mother-to-child HIV transmission and early infant diagnosis have reduced new pediatric HIV cases.
- Highly Active Antiretroviral Therapy (HAART) and Pneumocystis prophylaxis have decreased HIV-associated infections, especially respiratory ones.
Purpose of the Study:
- To review the current strategies for preventing and managing pulmonary diseases in HIV-infected children.
- To highlight the ongoing challenges in developing countries regarding HIV-associated respiratory diseases.
- To outline key interventions for preventing severe respiratory infections in children with advanced HIV.
Main Methods:
- Review of current diagnostic, therapeutic, and preventive strategies for pediatric HIV.
- Analysis of the impact of HAART and prophylaxis on respiratory infections.
- Examination of challenges in resource-limited settings.
Main Results:
- Significant reduction in pediatric HIV incidence due to prevention programs and early diagnosis.
- HAART and Pneumocystis prophylaxis have substantially decreased overall and respiratory infections.
- HIV-associated respiratory diseases remain a major concern in developing countries due to various socioeconomic factors.
Conclusions:
- Rapid and optimal initiation and continuation of HAART are crucial for preventing severe respiratory infections in advanced HIV.
- Preventive strategies include BCG vaccination, TB preventive treatment, cotrimoxazole prophylaxis for Pneumocystis jirovecii pneumonia, and age-appropriate vaccinations.
- Addressing socioeconomic factors is essential for comprehensive management of HIV-associated respiratory diseases in children, particularly in developing nations.
Abstract:
Despite advances in diagnostic, therapeutic and preventive strategies for HIV, pulmonary diseases continue to be the major cause of morbidity and mortality in infants and children infected with HIV. With effective programs to prevent perinatal HIV-1 transmission to early diagnosis in infants, we have seen a substantial decline in paediatric HIV incidence. Early initiation of Highly Active Anti-Retroviral Therapy (HAART) in all HIV infected children coupled with consistent use of Pneumocystis prophylaxis in all HIV exposed/infected children under 5 years of age has considerably reduced associated infections overall and respiratory infections in particular. In developing countries already burdened with poverty, malnutrition, suboptimal immunization coverage and limited access to health care and treatment, acute and chronic HIV-associated respiratory disease remain a major cause for concern. Prevention of severe respiratory infections in advanced HIV disease among children consists mostly of rapid and optimal HAART initiation & continuation, preventing severe TB disease with BCG and TB preventive treatment, preventing Pneumocystis jirovecii pneumonia with cotrimoxazole prophylaxis and administering age-appropriate vaccinations and catch-up vaccines as per National Immunization schedule.
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