The Time to Treat the Children Is Now

As the HIV pandemic spreads through regions of the world it takes a particularly discouraging toll on children and young adults-our collective future. Infants and children born to HIV-infected parents face a double threat: if they escape the 25%-40% risk of HIV infection through perinatal and breast-feeding exposure they remain at high risk for losing one or both parents to the disease. Of the 39.5 million people estimated to be living with AIDS globally as of December 2006 2.3 million were < 15 years old with ~530000 youngsters (1500/day) newly infected during the past year. Perhaps the greatest advance in HIV-related public health has been the use of antiretrovirals (ARVs) for the prevention of mother to child transmission (PMTCT). The initial report of the complex use of zidovudine by mother-infant pairs in the landmark AIDS Clinical Trials Group 076 study and the subsequent report of a simple single-dose nevirapine regimen used in HIV Network for Prevention Trial 012 and of many useful variations on these 2 models that followed have transformed PMTCT practices. Although partnerships between governments and nongovernmental organizations have developed broad PMTCT implementation programs significant limitations regarding penetration and uptake on a population scale remain to be solved. The result is a constant expansion of the ranks of HIV-infected children with recently infected newborns and young infants. (excerpt)