Clinical Review Regular review

HIV infection in children

BMJ 2001; 323 doi: (Published 22 September 2001) Cite this as: BMJ 2001;323:670
  1. Haroon Saloojee, senior lecturer (,
  2. Avy Violari, paediatric trials coordinatorb
  1. a Division of Community Paediatrics, Department of Paediatrics and Child Health, University of the Witwatersrand, PO Wits, 2050, Johannesburg, South Africa
  2. b Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Soweto, South Africa
  1. Correspondence to: H Saloojee

    HIV has transformed paediatric practice in developing countries. A specialty that once dealt mainly with acute illnesses is now consumed, in many settings, with managing chronically ill and dying children. Last year, 600 000 children were newly infected with HIV, over 90% in sub-Saharan Africa and almost all having acquired the virus by vertical transmission, from mother to child.1 The statistics do not adequately portray the suffering and disrupted lives of the most vulnerable of the world's population.

    The HIV pandemic has eroded many of the hard earned gains made in reducing infant and child mortality. The United Nations Program on HIV and AIDS (UNAIDS) recently reported that, by 2010, a doubling in child mortality is expected in regions with a high prevalence of infection. Globally, the number of orphans from AIDS will increase from the current 13.2 million to 44 million by 2010.2 Already, one child in 10 is an orphan in some countries. Finding appropriate responses to this crisis must rank as the single most important global challenge to child health in the next decade.

    This article reviews advances in preventing vertical transmission, antiretroviral treatment, and vaccine development, and we attempt to predict future developments.

    Summary points

    HIV infection and AIDS have severely disrupted child health services in many developing countries

    Efforts to prevent viral transmission form mother to child are inadequate in resource poor settings

    The choice between breast feeding and feeding with formula milk remains controversial

    An effective AIDS vaccine can be expected in the next 10 years

    New antiretroviral treatments and innovative treatment strategies continue to be developed

    A focus beyond education and promoting the use of condoms is required in poor countries


    The review is based on a Medline search of original papers and reviews, unpublished material, presentations and abstracts from recent scientific meetings, …

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