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Today, more than 25 years after the description of the first AIDS cases in children, major advances have been made on the prevention and treatment of the infection caused by human immunodeficiency virus (VIH-1), mainly after the availability of highly active antiretroviral therapy (HAART). Despite improved access to antiretroviral treatment and prevention, the HIV-infection epidemic continues to expand. The progression of the disease is much faster in children than in adults as well as the risk of complications. Since most infections occur perinatally, the virus overcomes the capacity of the immature immune system to control the HIV replication and dissemination occurs to all organ systems including the central nervous system (CNS). As a consequence the clinical course is more accelerated in children than in adults, and the immunological dysfunction is greater. Without antiretroviral treatment, HIV-infection in children has a bimodal pattern: a rapidly progressive form (15-20%) characterized by the development of severe opportunistic infections (OI), encephalopathy and death in the first 3 years, and a second form less aggressive and more alike to the presentation seen in adults, that accounts for around 80% of cases. Furthermore as there are no accurate prognostic surrogate markers of disease progression at diagnosis, most children should be treated early. Nevertheless, there is a delay in the development and implementation of antiretroviral treatment in children and adolescents. In addition, the need for a lifelong medication, with complex schedules, frequent high pill burden and lack of suitable paediatric formulation with insufficient data for children makes more difficult to maintain a permanent adherence to medication. Currently, although most children are on a stable situation with high CD4 counts and complete control of viral replication, the long-term consequences of the disease and of the accumulated effects of HAART are unknown and of major concern.

Clinical Manifestations of HIV-Infection in the Era of Highly Active Antiretroviral Therapy