Opportunistic Infections in HIV-Infected Children in the Era of Potent Antiretroviral Therapy
In the era before development of potent combination antiretroviral (ARV) treatment (cART) regimens, OIs were the primary cause of death in HIV-infected children. Current ART regimens suppress viral replication, provide significant immune reconstitution and have resulted in a substantial and dramatic decrease in AIDS-related OIs and deaths in both adults and children.[2–5]
Despite this progress, prevention and treatment of OIs remain critical components of care for HIV-infected children. HIV-associated OIs and other related infections continue to occur in HIV-infected children.[3,6] OIs continue to be the presenting symptom of HIV infection among children whose HIV-exposure status is unknown because of lack of maternal antenatal HIV testing. For infants and children with known HIV infection, barriers such as inadequate medical care, lack of availability of suppressive ARV regimens in the face of extensive prior treatment and drug resistance, caregiver substance abuse or mental illness and multifactorial adherence difficulties may hinder effective HIV treatment and put them at risk of OIs even in the ART era. These same barriers may then impede provision of primary or secondary OI prophylaxis to children for whom such prophylaxis is indicated. In addition, the addition of concomitant OI prophylactic drugs may only exacerbate the existing difficulties in adhering to ART. Multiple drug-drug interactions of OI, ARV and other compounds that result in increased adverse events and decreased treatment efficacy may limit the choice and continuation of both cART and prophylactic regimens. Finally, IRIS, initially described in HIV-infected adults but also seen in HIV-infected children, can complicate treatment of OIs when cART is started or when optimization of a failing regimen is attempted in patients with acute OIs. Thus, preventing and treating OIs in HIV-infected children remain important even in the cART era.
Pediatr Infect Dis J. 2013;32(12):1303-1307. © 2013 Lippincott Williams & Wilkins