In the past decade, there has been impressive success in the prevention of mother-to-child HIV transmission. However, we have not eliminated the problem of pediatric HIV infection, and much work remains to be done. Research in pediatric, adolescent, and maternal HIV infections is often a neglected area at major scientific HIV conferences, yet is critical to achieving an AIDS-free generation.
While we have highly effective interventions to prevent HIV transmission, implementation has been incomplete. In 2015, 1.8 million children were living with HIV and 150,000 were newly infected with the disease worldwide. Even with the continued scale-up of preventive services, it is estimated that 2 million children will need antiretroviral treatment (ART) in 2020. Unfortunately, children are substantially less likely than adults to be diagnosed, engaged in care, and to access lifesaving ART.
The treatment of pediatric HIV infection, particularly of infants and young children, remains complex and problematic. Rapid growth and organ system maturation, as well as emotional and cognitive changes that occur across the developmental spectrum from infancy through adolescence, complicate drug development and administration. Adherence outcomes in children have been less than robust and mental health and behavioral issues are emerging as critical to understand and address in order to ensure the success of long-term treatment. Additionally, while fewer infected children are being born, there are increasing concerns about the long-term impact of in utero and postnatal exposures to antiretroviral drugs for those children who escape HIV. Currently an estimated 20% of all infants born in sub-Saharan Africa are exposed to HIV and antiretrovirals during pregnancy and the postnatal period.
Young people account for half of all new cases of HIV infection worldwide, with adolescent girls and young women disproportionately affected. In sub-Saharan Africa in 2015, three out of four newly infected adolescents aged 15–19 years were girls. Adolescents living with HIV have been a particularly difficult group to reach. HIV was the leading cause of death among adolescents living in Africa and the second-leading cause of death in adolescents globally. The uptake of HIV testing among adolescents has remained low. Programs struggle to reach and retain adolescents in care and adherence to treatment has special challenges.
The pediatric HIV cure agenda is an important emerging area of research. Early infant diagnosis is increasingly available globally, enabling the earlier identification of infection and provides new exciting opportunities to study acute infection in children and promising cure strategies. The HIV Pediatrics Workshop is the only meeting entirely devoted to research in the prevention and treatment of HIV infections in infants, children, and adolescents, making it the premier forum for the world’s leading researchers.