Inserm, centre de recherche U897, épidémiologie et biostatistiques, institut de santé publique, d'épidémiologie et de développement (ISPED), université de Bordeaux - CS61292, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.
Inserm, centre de recherche U897, épidémiologie et biostatistiques, institut de santé publique, d'épidémiologie et de développement (ISPED), université de Bordeaux - CS61292, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.
Med Mal Infect. 2015 May;45(5):149-56. doi: 10.1016/j.medmal.2015.03.002. Epub 2015 Apr 7.
More than 90% of the estimated 3.2 million children with HIV worldwide, at the end of 2013, were living in sub-Saharan Africa. The management of these children was still difficult in 2014 despite the progress in access to antiretroviral drugs. A great number of HIV-infected children are not diagnosed at 6 weeks and start antiretroviral treatment late, at an advanced stage of HIV disease complicated by other comorbidities such as malnutrition. Malnutrition is a major problem in the sub-Saharan Africa global population; it is an additional burden for HIV-infected children because they do not respond as well as non-infected children to the usual nutritional care. HIV infection and malnutrition interact, creating a vicious circle. It is important to understand the relationship between these 2 conditions and the effect of antiretroviral treatment on this circle to taking them into account for an optimal management of pediatric HIV. An improved monitoring of growth during follow-up and the introduction of a nutritional support among HIV-infected children, especially at antiretroviral treatment initiation, are important factors that could improve response to antiretroviral treatment and optimize the management of pediatric HIV in resource-limited countries.
全球估计有 320 万艾滋病毒儿童感染者，截至 2013 年底，其中 90%以上生活在撒哈拉以南非洲地区。尽管抗逆转录病毒药物的可及性取得了进展，但在 2014 年，这些儿童的管理仍然很困难。大量艾滋病毒感染儿童未能在 6 周时被诊断出来，并且开始接受抗逆转录病毒治疗的时间较晚，此时已处于艾滋病毒疾病的晚期，并伴有其他合并症，如营养不良。营养不良是撒哈拉以南非洲地区全球人口的一个主要问题；对于艾滋病毒感染儿童来说，这是一个额外的负担，因为他们对常规营养护理的反应不如未感染儿童好。艾滋病毒感染和营养不良相互作用，形成恶性循环。了解这两种情况之间的关系以及抗逆转录病毒治疗对这种循环的影响，对于考虑将其纳入最佳儿童艾滋病毒管理中非常重要。在后续监测中更好地监测生长情况，并在开始抗逆转录病毒治疗时为艾滋病毒感染儿童提供营养支持，是改善抗逆转录病毒治疗反应和优化资源有限国家儿童艾滋病毒管理的重要因素。
