Management of vertically HIV-infected children in Europe.
OBJECTIVE
To describe policies for the therapeutic management of vertically HIV-infected children, and to compare these with practice, using children enrolled in a cohort study in the same setting.


METHODS
A postal questionnaire survey of clinicians in the paediatric centres of the European Collaborative Study (ECS) was used. Prospective data collected within the ECS on the treatment and clinical status of infected children seen in these centres in 1999-2001 were analysed and compared with the year 2000 policies reported.


RESULTS
In 3 of the 10 centres, the policy was routinely to administer antiretroviral therapy (ART) to infants upon confirmation of infection, and in 7 centres initiation of therapy was delayed until specific clinical, virological and immunological criteria were reached. Evidence of disease progression was a reason for treatment modification in all centres; other considerations included adherence problems and side effects. However, practice did not always match policy. For the 84 children with at least 5 y of follow-up (73 treated and 11 untreated), overall, 69% of the 420 person-years lived were spent without treatment, and 72% without any HIV-related symptoms. Untreated children were without symptoms for 94% of these 5 y, whereas treated children spent nearly a third of their time with mild or moderately severe symptoms.


CONCLUSIONS
Therapeutic management of paediatric HIV disease requires a balance between preventing disease progression and minimizing adherence problems and side effects. This is important, as most infected children are without symptoms most of the time. Recent European consensus guidelines for the treatment of infected children will facilitate management.
Thorne
C
C
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, UK.
Gray
L
L
Newell
M L
ML
D000293:Adolescent; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000592:standards / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005060:Europe; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission*; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*
D019380:Anti-HIV Agents