Dziuban Eric J, Rivadeneira Emilia D
From the Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia.
Pediatr Infect Dis J. 2016 Nov;35(11):1225-1228. doi: 10.1097/INF.0000000000001276.
Antiretroviral treatment coverage for children living with HIV is low, and new efforts are underway to expand eligibility so that all children and adolescents qualify for the treatment regardless of immune suppression or clinical stage. Although recent trials provide direct evidence of the benefit of this approach in adults, no such studies have been performed in children. This report examines the available body of evidence regarding universal HIV treatment for children and adolescents and assesses the benefits and challenges both at individual patient health, as well as at programmatic level. Universal treatment eligibility for children with HIV has great potential for improved growth and neurodevelopment and fewer morbidities for children, and treatment coverage would be expected to increase through guideline simplification. However, concerns regarding toxicities, drug resistance and costs require careful planning. Successful implementation will depend on effective strategies for case-finding, treatment adherence support and program monitoring that will contribute to the growing evidence base for this pivotal pediatric HIV policy shift.
感染艾滋病毒儿童的抗逆转录病毒治疗覆盖率较低，目前正在做出新的努力以扩大治疗资格范围，使所有儿童和青少年无论免疫抑制情况或临床阶段如何都有资格接受治疗。尽管最近的试验提供了这种方法对成年人有益的直接证据，但尚未在儿童中开展此类研究。本报告审查了有关儿童和青少年普遍艾滋病毒治疗的现有证据，并评估了在个体患者健康以及项目层面的益处和挑战。对感染艾滋病毒儿童实行普遍治疗资格对改善其生长发育和神经发育具有巨大潜力，并可减少儿童发病情况，而且预计通过简化指南可提高治疗覆盖率。然而，对毒性、耐药性和成本的担忧需要仔细规划。成功实施将取决于有效的病例发现策略、治疗依从性支持和项目监测，这将有助于为这一关键的儿科艾滋病毒政策转变积累越来越多的证据。
