Buchholz B, Hien S, Weichert S, Tenenbaum T
Department of Paediatrics, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
Minerva Pediatr. 2010 Aug;62(4):371-87.
Mother-to-child transmission of HIV1 is the main cause for pediatric HIV1-infection. Since 1995 in developed countries the rate of vertical HIV1 transmission was reduced from 40% to 1-2% by the combination of antiretroviral therapy of pregnant women, antiretroviral prophylaxis in the newborn and refraining from breast-feeding. Nowadays the main causes for HIV1-infection in children are 1) not offered (voluntary) HIV1-testing in early pregnancy (in spite of recommendation for prenatal care) and 2) missing knowledge about prophylactic interventions in HIV1-positive pregnant women and their HIV1-exposed newborn. Diagnosis and/or exclusion of HIV1-infection in HIV1-exposed and HIV1-positive infants is difficult, because maternal HIV1-antibodies pass the placenta and can persist in the child up to two years after birth. Since in 1996 the era of "highly active antiretroviral therapy (HAART)", the use of an antiretroviral three-drug-regimen, began, HIV1-infection in children changed from a fatal illness to a chronic disease with decreased mortality and improved qualitiy of life. The lack of drug approvement, absence of adequate drug formulation and of pharmacokinetic data for children make the treatment of HIV1-infection in children much more difficult than in adults. Treatment of children depends on clinical category, CD4 cell count, viral load and age of diagnosis. With the current state of knowledge (failure of treatment interruption studies in adults and pending ones in children) once HAART is started it must be carried on life-long. This implies great challenges in adherence to avoid development of resistance and in confrontation with long-term adverse effects of HIV1-therapy.
HIV-1母婴传播是儿童感染HIV-1的主要原因。自1995年以来，在发达国家，通过对孕妇进行抗逆转录病毒治疗、对新生儿进行抗逆转录病毒预防以及避免母乳喂养，垂直传播HIV-1的比率从40%降至1%-2%。如今，儿童感染HIV-1的主要原因是：1）妊娠早期未提供（自愿的）HIV-1检测（尽管有产前检查的建议）；2）HIV-1阳性孕妇及其接触HIV-1的新生儿缺乏预防性干预措施的相关知识。诊断和/或排除接触HIV-1和HIV-1阳性婴儿的HIV-1感染很困难，因为母体HIV-1抗体可通过胎盘，并能在儿童体内持续至出生后两年。自1996年“高效抗逆转录病毒治疗（HAART）”时代开始，即使用抗逆转录病毒三联药物疗法以来，儿童HIV-1感染已从一种致命疾病转变为一种死亡率降低、生活质量改善的慢性病。药物未获批准、缺乏适合儿童的药物剂型以及药代动力学数据，使得儿童HIV-1感染的治疗比成人困难得多。儿童的治疗取决于临床分类、CD4细胞计数、病毒载量和诊断时的年龄。鉴于目前的知识水平（成人治疗中断研究失败，儿童相关研究尚在进行中），一旦开始HAART治疗，就必须终身进行。这在坚持治疗以避免耐药性发展以及应对HIV-1治疗的长期不良反应方面意味着巨大挑战。
