Clinical management of HIV infection in children.
OBJECTIVE
The aim of this article is to review recent advances in the clinical care of HIV-infected children.


RESULTS
Obstacles to diagnosing HIV in children and providing clinical care to those HIV infected relate to a number of technical and operational factors. Most countries now have antiretroviral treatment guidelines and have incorporated co-trimoxazole prophylaxis for infected and exposed infants and children. Implementation lags behind policy and technical recommendations. Optimal early infant feeding remains difficult and, while breastfeeding remains the safest feeding option for child survival, it carries with it the risk of HIV acquisition. Recent data suggest HIV-free survival at 18 months is comparable in infants who are replacement-fed or exclusively breastfed for the first 6 months of life. Antiretroviral treatment efficacy in children is now well documented. Optimal timing of initiation of antiretroviral treatment remains uncertain; in general it is started earlier, especially in infants. Children starting treatment in infancy are surviving and reaching adulthood; new problems of managing the highly treatment-experienced and adolescents are emerging.


CONCLUSIONS
New antiretroviral drugs and classes will be needed for the future; research is urgently required to characterize optimal nutritional interventions, interpretation of immunological and virological parameters, and develop diagnostic tools for use in health services with limited infrastructure and capacity.
aPaediatric and Family HIV Care, Department of HIV/AIDS, World Heath Organization, Geneva, Switzerland bBaylor College of Medicine Children's Foundation-Uganda, Mulago Hospital PIDC, Kampala, Uganda cPediatric Day Hospital Director, Maputo Central Hospital, Maputo, Mozambique.
Siobhan
S
Crowley
Adeodata
A
Kekitiinwa
Paula
P
Vaz