HIV This Week

Sutcliffe CG, van Dijk JH, Bolton C, Persaud D, Moss WJ. Effectiveness of antiretroviral therapy among HIV-infected children in sub-Saharan Africa. Lancet Infect Dis. 2008;8(8): 477–89.

Assessment of antiretroviral treatment programmes for HIV-infected children in sub-Saharan Africa is important to enable the development of effective care and improve treatment outcomes. Sutcliffe and colleagues review the effectiveness of paediatric antiretroviral treatment programmes in sub-Saharan Africa and discuss the implications of these findings for the care and treatment of HIV-infected children in this region. Available reports indicate that programmes in sub-Saharan Africa achieve treatment outcomes similar to those in North America and Europe. However, progress in several areas is required to improve the care of HIV-infected children in sub-Saharan Africa. The findings emphasise the need for low-cost diagnostic tests that allow for earlier identification of HIV infection in infants living in sub-Saharan Africa, improved access to antiretroviral treatment programmes, including expansion of care into rural areas, and the integration of antiretroviral treatment programmes with other health-care services, such as nutritional support.

Editor’s Note: Although this review of 30 sub-Saharan African paediatric studies in urban centers reveals early clinical, immunological, or virological outcomes and treatment adherence similar to those reported from high-income countries, there are concerns. At treatment entry, children are older (most are more than 5 years), more immunosupressed, and more undernourished (more than half). Palatable, stable liquid preparations and fixed-dose antiretroviral combinations are not usually available and second-line regimes (up to 59% of children had treatment failure or adverse reactions) costly. Standardised monitoring and assessment systems are not in place and these are key to quality assurance as services expand to rural areas.