52
Vol. 66, No. 3 2015
Northeast Florida Medicine
CME
An Update on Pediatric HIV
Introduction
Pediatric HIV infection remains a global problem.
Although there have been tremendous advances in HIV
medicine over the last three decades of the epidemic, not
all communities throughout the world have benefited from
these advances. In the developed world, HIV is now a
chronic, manageable and treatable disease that is akin to
hypertension or diabetes. Unfortunately that is not the
case in the under resourced parts of the world. Through
the efforts of the World Health Organization (WHO)
and programs such as the US government-sponsored
President’s Emergency Plan for AIDS Relief (PEPFAR)
many more HIV infected individuals than before are
being helped. However, there is still a long way to go.
Locally manufactured antiretroviral medications,
which are much less expensive and more affordable for
the under resourced nations, have been a great help in
making these antiretroviral available to more persons with
HIV infection then would have otherwise been possible.
However, the presence of other familiar problems, such
as lack of safe and clean drinking water, poor nutrition
and tuberculosis, makes management of HIV in most
countries of the world an even bigger challenge. Abject
poverty in many of the countries where HIV prevalence
is high makes it a huge challenge to establish a health-
care infrastructure that can handle and control ongoing
Abstract:
The management of HIV infection has improved
significantly over the last three decades of the epidemic. The
treatment of pediatric HIV infection has benefited significantly from
the progress. Of the advances, the most significant is the success of
prevention of mother to child transmission of HIV infection.
epidemics such as HIV and newer ones such as Ebola.
Table 1 shows the latest available data from the WHO.
1
Since the onset of the HIV epidemic there have been
many successes. However, arguably three sentinel events
have defined this epidemic. The first was the discovery by
French investigators of the virus responsible for causing
AIDS. Second was the development and approval by the
Food and Drug Administration of the very first antiret-
roviral drug Zidovudine (ZDV, originally abbreviated as
AZT) developed by the British pharmaceutical company
GlaxoSmithKline. Third was the ability to prevent mother
to childHIV transmission (MTCT) proven by the Pediatric
AIDS Clinical trial (PACTG) study 076,
2
conducted by
the National Institutes of Health in the United States.
HIV can be transmitted by several mechanisms includ-
ing sexual contact, intravenous drug abuse, exposure to
blood and body fluids (including needles), transfusion
of infected blood and blood products (a route that no
longer occurs in the United States of America) andMTCT.
MTCT
Since the early 1990s PACTG 076 has been the standard
of care in the United States decreasing the MTCT (also
referred to as perinatal transmission) to < 1 percent.
3
In
Jacksonville, under the auspices of University of Florida
By Mobeen Rathore, MD, CPE, FAAP, FPIDS, FIDSA, FACPE, FSHEA
Professor and Director, University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES)
Chief, Pediatric Infectious Diseases, Wolfson Children’s Hospital
Address correspondence to:
Mobeen Rathore, MD, CPE, FAAP, FPIDS, FIDSA, FACPE, FSHEA
Professor and Director, UF CARES
University of Florida Center for HIV/AIDS,
Research, Education & Service
653-1 West 8
th
Street, LRC 3
rd
Floor L-13
Jacksonville, FL 32209
Table 1:
