S.N. Mothi*, S. Karpagam**, V.H.T. Swamy+, M. Lala Mamatha++ & S.M. Sarvode†
*Asha Kirana Hospital, Mysore, YRG CARE, Chennai, JSS University, Mysore, **Asha Kirana Charitable Trust,
Mysore, +Asha Kirana Hospital, Mysore, ++Committed Communities Development Trust/MSF/SHED;
Wadia Group of Hospitals, Mumbai & †Asha Kirana Hospital, Mysore, India
With the availability of antiretroviral therapy (ART), HIV infection, which was once considered a progressively fatal illness, has now become a chronic treatable condition in children, as in adults. However, the challenges these children are forced to face are far more daunting. The most significant shortcoming in the response to paediatric HIV remains the woefully inadequate prevention of mother to- child transmission (PMTCT), allowing a large number of children to be born with HIV in the first place, in spite of it being largely preventable. In the west, mother-to-child transmission has been virtually
eliminated; however, in resource-limited settings where >95 per cent of all vertical transmissions take place, still an infected infants continue to be born. There are several barriers to efficient management: delayed infant diagnosis, lack of appropriate paediatric formulations, lack of skilled health personnel, etc. Poorly developed immunity allows greater dissemination throughout various organs. There is an increased frequency of malnutrition and infections that may be more persistent, severe and less responsive to treatment. In addition, these growing children are left with inescapable challenges of facing
not only lifelong adherence with complex treatment regimens, but also enormous psychosocial, mental and neuro-cognitive issues. These unique challenges must be recognized and understood in order to provide appropriate holistic management enabling them to become productive citizens of tomorrow.
To address these multi-factorial issues, there is an urgent need for a concerted, sustainable and multipronged national and global response.
Key words Challenges – clinical diagnosis – clinical manifestations – early infant diagnosis – immunization in children with HIV – management – nutrition – psychosocial issues – paediatric HIV – trends