Rate of new pediatric HIV infections remains high in developing world

Slow movement on prevention interventions and an increasing number of prophylaxis failures have contributed to the 2 million children who are infected with HIV worldwide, according to findings presented at the 17th Conference on Retroviruses and Opportunistic Infections, held in San Francisco.

“Away from the developed world, the pediatric HIV epidemic rages,” said Elaine Abrams, MD, of the Mailman School of Public Health at Columbia University. “There are 1.8 million pediatric cases of HIV in sub-Saharan Africa alone.”

Abrams said perinatal mother-to-child transmission prevention programs are often layered onto other prevention programs. Therefore, there are limited resources for complex medical interventions.

Another contributing factor to pediatric HIV rates is excessive reliance on short-course antiretroviral therapy. Until recently, no postnatal prevention methods have been shown effective, she said.

“There has been a systematic failure to identify and treat pregnant women who are eligible for therapeutic ART,” Abrams said.

Comprehensive prevention service delays have also contributed to the increasing number of pediatric HIV infections. Also, the threat of resistance is an increasing concern for many ART regimens used to prevent mother-to-child transmission.

“Single-dose nevirapine alone or used in combination with short-course AZT are the most commonly used regimens to prevent mother-to-child transmission,” she said. “The concern with single-dose nevirapine is that it selects drug-resistant viral mutations among a large proportion of children who fail prophylaxis, which compromises outcomes of non-nucleotide reverse transcriptase inhibitor-based treatment regimens when used in these infants.”

Abrams said there are four areas in which efforts to reduce pediatric infections have been focused: prevention of HIV in women, prevention of unwanted pregnancies, prevention of mother-to-child transmission, and care and treatment of women with HIV.

“All of these areas present challenges,” she said. “However, it is worth noting that there are 80 million unwanted pregnancies annually worldwide.”

Abrams said ART scale-up will likely lead to fewer infected children, but it may also lead to a significant number of children with resistant virus. — by Rob Volansky

For more information:

Abrams E. Putting the “C” into MTCT — saving kids. Presented at: 17th Conference on Retroviruses and Opportunistic Infections; Feb. 16-19, 2010; San Francisco.