The Indian pediatric HIV epidemic: a systematic review.
Despite an estimated 70,000 Indian children living with HIV infection, little is known about India's pediatric HIV epidemic. Generalizations about epidemiology, natural history, and treatment outcomes from other resource-limited settings (RLS) may be inaccurate for several biologic and social reasons. A review of the Indian literature is needed to optimize country-specific HIV management and examine these generalizations. MEDLINE and EMBASE were searched for articles published in English by November 2007 on HIV-infected, Indian children (0-18 years) that detailed epidemiology, natural history, or treatment. Articles with original, extractable data were selected and summarized using descriptive statistics. Of 370 citations, 58 studies were included in this review (median study size 24 children). Significant heterogeneity was noted among the studies. HIV infection was reported nearly twice as often in males (male/female ratio 1.9) and diagnosed earlier (4.7 years) than in other RLS. Over 2% of hospitalized children were reported to be HIV-infected. The reported mortality among HIV-infected newborns of 22% at 18 months was lower than other RLS. Improved anthropometrics were the only consistently reported and comparable benefit of short-term HAART to other RLS. Review of the Indian literature yielded potentially unique epidemiology and natural history compared to other RLS. However, important questions about the accuracy and representativeness of the Indian data limit its generalizability and comparability. Targeted interventions to curb India's pediatric HIV epidemic require urgent clarification of these findings. If such differences truly exist, management guidelines should be tailored accordingly.
Singh
Harjot Kaur
HK
Johns Hopkins University School of Medicine, Division of Infectious Diseases, Baltimore, MD 21287, USA. hsingh3@jhmi.edu
Gupta
Amita
A
Siberry
George Kelly
GK
Gupte
Nikhil
N
Sastry
Jayagowri
J
Kinikar
Arti
A
Shah
Ira
I
Gangakhedkar
Raman Raghunathrao
RR
Bollinger
Robert Cyril
RC
Kulkarni
Vinay
V
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017720:Molecular Epidemiology; D012737:Sex Factors