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Pediatric HIV: Australian perspective
J B Ziegler1, P Palasanthiran, M Cruickshank
1Paediatric AIDS Unit, Prince of Wales Children's Hospital, Randwick, Australia.
Insights
Pediatric human immunodeficiency virus (HIV) transmission in Australia is linked to maternal seroprevalence. Early detection and treatment, like zidovudine, can improve outcomes for infected children.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health
Background:
- Pediatric HIV infection rates in Australia mirror maternal HIV seroprevalence.
- Perinatal HIV transmission rates are approximately 30%, higher in breastfed infants.
Purpose of the Study:
- To review the current understanding of pediatric HIV infection in Australia.
- To discuss diagnostic and therapeutic strategies for vertically infected children.
Main Methods:
- Literature review and synthesis of existing data on pediatric HIV in Australia.
- Analysis of perinatal transmission rates, diagnostic methods, and treatment options.
Main Results:
- Exclusive bottle-feeding may reduce perinatal HIV transmission risk to below 20%.
- Clinical and laboratory markers (p24, PCR, viral culture) aid early HIV detection in infants.
- Zidovudine shows efficacy in children, while didanosine has a favorable toxicity profile despite poor bioavailability.
Conclusions:
- Routine antenatal screening for HIV may not be cost-effective in low-prevalence Australia.
- Early diagnosis and treatment with agents like zidovudine are crucial for managing pediatric HIV.
- Support systems like family camps can mitigate social isolation for HIV-affected families.
Abstract:
Pediatric infection with human immunodeficiency virus (HIV) in Australia, as elsewhere, now reflects HIV seroprevalence in women of childbearing age although numbers remain small. A perinatal transmission rate of approximately 30% has been observed. The rate appears to be higher for breast-fed babies; exclusively bottle-fed babies of HIV-infected mothers appear to have a risk of < 20% of acquiring HIV perinatally. Although the seroprevalence rate in women of childbearing age in Australia remains low, routine antenatal screening will not be cost-effective. Although passively acquired maternal antibody may confound serodiagnosis for up to 18 months, in practice, HIV infection, when present, can be detected clinically or with use of other laboratory parameters (p24, polymerase chain reaction, viral culture, hyperglobulinemia) during the first 6 months of life. Zidovudine appears to be relatively nontoxic in children and effective in producing weight gain and preventing opportunistic infection. Although experience with didanosine is limited, this drug appears to have a very acceptable toxicity profile and the advantage of twice-daily dosing. However, the bioavailability and penetration into the cerebrospinal fluid are poor. Neurological disease can improve when absorption is adequate. Residential family camps may help to reduce isolation for families and provide them with an opportunity for improving their understanding of HIV through interaction with peers and professionals.