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n Southern African Journal of HIV Medicine - Starting infants on antiretroviral therapy : clinical : paediatrics
The most effective way to combat paediatric HIV infection is through good management of maternal health and prevention of mother-to-child transmission (PMTCT). However, by the end of 2007, of an estimated 33.2 million people living with HIV, 2.1 million were children. Of these 90% lived in sub-Saharan Africa and 420 000 were newly infected in that year.
Although in recent years the number of children treated with antiretroviral therapy (ART) has increased from about 75 000 in 2005 to almost 200 000 in 2007, many children living with HIV are not receiving treatment. Without it approximately 35% will die before their first birthday and 53% by the time they reach the age of 2 years. By age 5 years it is estimated that 62 - 89% of children will have died.
Emerging data from sub-Saharan Africa show that most children starting ART are doing so at older ages, usually 5 years or more, that most start at a late stage of the disease, and that mortality in the first few months of treatment remains high.
A recent study shows that starting treatment in early infancy can be lifesaving, and this has informed revisions in World Health Organization (WHO) guidelines (see WHO 'Dear Health Care Provider' letter, Fig. 1). At present the majority of children who could benefit from these recommendations are not being diagnosed or treated.
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