Clinical Trials Unit, Medical Research Council, and Department of Infectious Diseases and Microbiology, Institute of Child Health, University College London, 30 Guilford St., London, UK.
AIDS. 2012 Dec;26 Suppl 2:S105-16. doi: 10.1097/QAD.0b013e32835bddfc.
Success in diagnosing and treating HIV-infected adults has, where HIV care and treatment is available, turned HIV into a chronic, rather than life-limiting disease. Progress meeting the needs of HIV-infected children, perinatally and horizontally infected adolescents, pregnant women and older people has lagged behind. We review the special needs and barriers to scaling up care and antiretroviral therapy (ART) coverage in these populations.
A literature review combined with personal views and operational experience specifically from countries covered by the Evidence for Action programme.
Challenges include logistics of diagnosis and treatment in pregnancy, difficulties in early infant diagnosis, availability of appropriate paediatric formulations, management of adolescents, and comorbidities in older people.
Priorities for development need to focus upon the simplification of HIV care to allow provision for all ages at the primary healthcare level. Specific priorities include focused use of virological testing in infants, ongoing development of dispersible and scored fixed-dose ART combinations suitable for use across ages, development of 'adolescent-friendly' HIV services catering for perinatally and horizontally infected adolescents to improve adherence and reduce onward transmissions, simplification of referral pathways to ensure all pregnant women are tested for HIV and commenced on ART, and education of healthcare workers on the specific needs of HIV care in older patients. Each priority will be reviewed and potential solutions discussed.
在提供艾滋病毒护理和治疗的地方，艾滋病毒感染者的诊断和治疗取得了成功，艾滋病毒已成为一种慢性疾病，而不是危及生命的疾病。满足艾滋病毒感染儿童、经母婴垂直传播和经性途径感染的青少年、孕妇和老年人需求的进展落后了。我们审查了在这些人群中扩大护理和抗逆转录病毒治疗（ART）覆盖面的特殊需求和障碍。
文献综述结合个人观点和具体来自行动证据方案涵盖国家的业务经验。
挑战包括妊娠期间诊断和治疗的后勤问题、早期婴儿诊断的困难、适当儿科配方的可用性、青少年的管理以及老年人的合并症。
需要优先考虑简化艾滋病毒护理，以便在初级保健层面为所有年龄段提供护理。具体的优先事项包括在婴儿中更有针对性地使用病毒学检测，不断开发适合各年龄段使用的可分散和可刻痕固定剂量抗逆转录病毒组合，为经母婴垂直传播和经性途径感染的青少年开发“青少年友好”艾滋病毒服务，以提高依从性并减少传播，简化转诊途径，确保所有孕妇都接受艾滋病毒检测并开始接受 ART 治疗，以及对医护人员进行艾滋病毒护理在老年患者中的特殊需求的教育。将对每个优先事项进行审查并讨论潜在的解决方案。
