WHO guidelines for the use of ART in children
- 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
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
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- 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.