WHO guidelines for the use of ART in children

[Guest guest]

WHO guidelines for the use of ART in children

Antiretroviral therapy of HIV infection in infants and children in

resource-limited settings: towards universal access: Recommendations

for a public health approach

The most efficient and cost-effective way to tackle paediatric HIV

globally is to reduce mother-to-child transmission (MTCT). However,

every day there are nearly 1500 new infections in children under 15

years of age, more than 90% of them occurring in the developing

world and most being associated with MTCT (1). HIV-infected infants

frequently present with clinical symptoms in the first year of life,

and by one year of age an estimated one-third of infected infants

will have died, and about half by 2 years of age (2, 3). There is

thus a critical need to provide antiretroviral therapy (ART) for

infants and children who become infected despite the efforts being

made to prevent such infections.

In countries where it has been successfully introduced, ART has

substantially changed the face of HIV infection. HIV-infected

infants and children now survive to adolescence and adulthood. The

challenges of providing HIV care have therefore evolved to become

those of chronic as well as acute care. In resource-limited

settings, many of which are countries hardest hit by the epidemic,

unprecedented efforts made since the introduction of the `3 by 5'

targets and global commitments to rapidly scale up access to ART

have led to remarkable progress. However, this urgency and intensity

of effort have met with less success in extending the provision of

ART to HIV-infected children. Significant obstacles to scaling up

paediatric care remain, including limited screening for HIV, a lack

of affordable simple diagnostic testing technologies, a lack of

human capacity, insufficient advocacy and understanding that ART is

efficacious in children, limited experience with simplified

standardized treatment guidelines, and a lack of affordable

practicable paediatric antiretroviral (ARV) formulations.

Consequently, far too few children have been started on ART in

resource-limited settings. Moreover, the need to treat an increasing

number of HIV-infected children highlights the primary importance of

preventing the transmission of the virus from mother to child in the

first place.

WHO guidelines for the use of ART in children were considered within

the guidelines for adults published in 2004 (4). Revised, stand-

alone comprehensive guidelines based on a public health approach

have been developed in order to support and facilitate the

management and scale-up of ART in infants and children.

The present guidelines are part of WHO's commitment to achieve

universal access to ART by 2010. Related publications include the

revised treatment guidelines for adults (i.e. the 2006 revision),

revised guidelines on ARV drugs for treating pregnant women and

preventing HIV infection in infants, guidelines on the use of co-

trimoxazole preventive therapy (CPT),(i) and revised WHO clinical

staging for adults and children (5). (i) These three documents are

currently in preparation and are expected to be published by WHO in

2006.

Download file in English [pdf 1.54Mb]

http://www.who.int/hiv/pub/guidelines/WHOpaediatric.pdf

[Guest guest]

Dear forum members,

It is good to receive such guidelines from time to time and thus we all should

welcome the initiative from WHO. It helps clinicians monitor themselves in the

absence of any national guidelines.

The original mail brings out a point for critical discussion.

As is mentioned by the author the most efficient and cost-effective way to

tackle paediatric HIV globally is to reduce mother-to-child transmission (MTCT).

In keeping with this WHO has also recently published its new guidelines for

PMTCT (August 2006). These are a modification over the last year's WHO

guidelines.

For us in India, the NACO guidelines last published (and thus the only ones

available today) are the only guiding principles. They are still different from

the WHO guidelines. Given the resources, expertize and reasonably strong network

of public health care facilities in India, we feel, India should be adopting

more effective regimens and not the ones which have less efficiency, even in the

public sector.

We are waiting for NACO to provide us with updated guidelines.

PRAYAS

Pune

e-mail: <prayashealth@...>