Introduction
As highly active
antiretroviral therapy (HAART) transforms human immunodeficiency virus (HIV)
into a manageable chronic disease, new challenges are emerging in treating
children born with HIV, including a number of risks to their physical and
psychological health due to HIV infection and its lifelong treatment.
Methods
We conducted a
literature review to evaluate the evidence on the physical and psychological
effects of perinatal HIV (PHIV+) infection and its treatment in the era of
HAART, including major chronic comorbidities.
Results and discussion
Perinatally infected
children face concerning levels of treatment failure and drug resistance, which
may hamper their long-term treatment and result in more significant
comorbidities. Physical complications from PHIV+ infection and treatment
potentially affect all major organ systems. Although treatment with
antiretroviral (ARV) therapy has reduced incidence of severe neurocognitive
diseases like HIV encephalopathy, perinatally infected children may experience
less severe neurocognitive complications related to HIV disease and ARV
neurotoxicity. Major metabolic complications include dyslipidaemia and insulin
resistance, complications that are associated with both HIV infection and
several ARV agents and may significantly affect cardiovascular disease risk
with age. Bone abnormalities, particularly amongst children treated with
tenofovir, are a concern for perinatally infected children who may be at higher
risk for bone fractures and osteoporosis. In many studies, rates of anaemia are
significantly higher for HIV-infected children. Renal failure is a significant
complication and cause of death amongst perinatally infected children, while
new data on sexual and reproductive health suggest that sexually transmitted
infections and birth complications may be additional concerns for perinatally
infected children in adolescence. Finally, perinatally infected children may
face psychological challenges, including higher rates of mental health and
behavioural disorders. Existing studies have significant methodological
limitations, including small sample sizes, inappropriate control groups and
heterogeneous definitions, to name a few.
Conclusions
Success in treating
perinatally HIV-infected children and better understanding of the physical and
psychological implications of lifelong HIV infection require that we address a
new set of challenges for children. A better understanding of these challenges
will guide care providers, researchers and policymakers towards more effective
HIV care management for perinatally infected children and their transition to
adulthood.
Full article at: http://goo.gl/Qh85Da
By: Rachel C Vreeman,§,1,2,3 Michael L Scanlon,*,1,2 Megan S McHenry,*,1,2 and Winstone M Nyandiko*,2,3
1Children's Health Services Research,
Department of Pediatrics, Indiana University School of Medicine, Indianapolis,
IN, USA
2Academic Model Providing Access to Healthcare
(AMPATH), Eldoret, Kenya
3Department of Child Health and
Paediatrics, School of Medicine, College of Health Sciences, Moi University,
Eldoret, Kenya
§Corresponding author: Rachel C Vreeman, Children’s Health Services
Research, Department of Pediatrics, Indiana University School of Medicine, 410
W. 10th Street, HITS Suite 1000, Indianapolis, IN 46202, USA. Tel: +1 317 278
0552. Fax: +1 317 278 0456. (Email:ude.ui@nameervr)
More at: https://twitter.com/hiv_insight
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