The diagnosis and treatment of HIV-infected children in China: challenges and opportunities.
BACKGROUND
HIV-infected children in China have not been well studied. This national survey describes the demographic characteristics and the associated diagnostic and antiretroviral treatment (ART) efforts directed toward surviving HIV-infected children.


METHODS
A cross-sectional study was conducted in the 6 provinces with the highest HIV prevalence: 4 former plasma donation (FPD) provinces and 2 intravenous drug use (IDU) provinces. A survey on demographics and treatment-related issues was distributed to the parents or guardians of all living HIV-infected children identified through the national case reporting system. Descriptive and bivariate analyses were performed on completed surveys.


RESULTS
Six hundred ninety-two (62.4%) of the total 1108 surveys were returned, and 650 were eligible for analysis. The average age in FPD provinces (mean +/- SD: 8.1 +/- 3.2 years) was significantly older than in IDU provinces (mean +/- SD: 5.4 +/- 2.2 years; P < 0.001). The average lag time from the probable date of transmission to a diagnosis for patients with mother-to-child transmission (MTCT) was 6.7 +/- 3.1 years in the FPD provinces and 4.7 +/- 1.9 years in the IDU provinces (P < 0.001). On the basis of the CD4 cell count or World Health Organization staging, 29.8% (144 of 484) of children from all 6 provinces who were not on ART needed it.


CONCLUSIONS
This first national pediatric survey indicates that the age and time required for diagnosis were greater in HIV-infected children from FPD provinces compared with those from IDU provinces. In addition, this survey highlights the prolonged delay in the diagnosis and initiation of ART for children in China. Aggressive efforts to identify HIV-positive pregnant women, scale up prevention of MTCT activities, and expand early diagnosis and treatment are urgently needed.
Zhang
Fujie
F
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control, Beijing, People's Republic of China.
Au
Maria C
MC
Bouey
Paul D
PD
Zhao
Yan
Y
Huang
Zhihuan Jennifer
ZJ
Dou
Zhihui
Z
Li
Zaicun
Z
Haberer
Jessica
J
Chen
Ray Y
RY
Yu
Lan
L
D000704:Analysis of Variance; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D002681:China; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D006306:Health Surveys; D006801:Humans; D008297:Male; D010951:Plasma Exchange / Q000706:statistics & numerical data
D044966:Anti-Retroviral Agents