title: Survival of HIV-1 vertically infected children.
abstract: It is 20 years since the start of the combination antiretroviral therapy (cART) era and more than 10 years since cART scale-up began in resource-limited settings. We examined survival of vertically HIV-infected infants and children in the cART era.
  
  
  
  Good survival has been achieved on cART in all settings with up to 10-fold mortality reductions compared with before cART availability. Although mortality risk remains high in the first few months after cART initiation in young children with severe disease, it drops rapidly thereafter even for those who started with advanced disease, and longer term mortality risk is low. However, suboptimal retention on cART in routine programs threatens good survival outcomes and even on treatment children continue to experience high comorbidity risk; infections remain the major cause of death. Interventions to address infection risk include a cotrimoxazole prophylaxis, isoniazid preventive therapy, routine childhood and influenza immunization, and improving maternal survival.
  
  
  
  Pediatric survival has improved substantially with cART and HIV-infected children are aging into adulthood. It is important to ensure access to diagnosis and early cART, good program retention as well as optimal comorbidity prophylaxis and treatment to achieve the best possible long-term survival and health outcomes for vertically infected children.
authors.affiliation: aCentre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South AfricabMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College LondoncImperial College Healthcare Trust, St Mary's Hospital, London, UK.
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Diana
authors.initials: D
authors.lastname: Gibb
authors.forename: Anna
authors.initials: A
authors.lastname: Turkova
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality* / Q000635:transmission*; D006801:Humans; D015994:Incidence; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents