Background

Infection with the human immunodeficiency virus (HIV) causes acquired immunodeficiency
syndrome (AIDS), which affects the cells of the immune system, and destroys or impairs their
function. The virus is transmitted through direct contact with an infected mucosal membrane or
bodily fluids such as blood, semen, and breast milk. After an initial frequently asymptomatic
phase, skin problems and upper respiratory tract infections develop, and patients begin to lose
weight. Chronic diarrhoea, persistent fever, fungal or bacterial infections, and tuberculosis may
follow. As the disease progresses, the immune system deteriorates, slowly losing its ability to
fight other infections and diseases, and ultimately leading to immune deficiency.

Immunodeficient people are prone to opportunistic infections and cancers. There is no cure or
vaccine currently available, but the availability of effective antiretroviral therapy has
significantly decreased mortality and increased survival times of HIV-infected people in highincome countries. However, antiretroviral drugs are generally expensive, and access to
diagnostic tests and treatments in low- to middle-income countries has been insufficient. Over
the past decade, competition from generic pharmaceutical companies has dramatically decreased
the price of antiretrovirals, although newer generation drugs remain prohibitively expensive.

Most children acquire HIV through perinatal transmission during pregnancy, childbirth, or whilst
breast-feeding. Prevention programmes can reduce the risk of transmission from 30-40% down
to less than 5%. Increased access to these programmes will lead to better health of HIV-positive
pregnant women and to lower numbers of infants infected. Infants who acquire HIV around
delivery develop the disease rapidly during the first few months and die, often before they are
even diagnosed with the virus.

Source: WHO, UNAIDS, 2012.

Whereas in high-income countries most HIV-positive pregnant women have access to good
quality antenatal care and receive antiretroviral therapy, women in resource-limited settings have
little access to these services. Moreover, pregnant women with HIV in high-income countries are
advised to use reconstituted formula milk, whereas in developing countries safe drinking water is
often not readily available and the risk of acquiring infections from bottle-feeding can be high.

HIV progression is more rapid in children than in adults, and the disease has a more devastating
effect on an infants body. Children fail to grow and gain weight at the normal rate, and may
experience feeding difficulties due to oral thrush, mouth sores or loss of appetite, or
malabsorption due to persistent diarrhoea. Severe wasting is common, and can be exacerbated by
malnutrition, leading to life-threatening problems.

Tuberculosis (TB) is currently the leading cause of death of people living with HIV in Africa and
HIV-positive children are more susceptible to TB infection. Increased financial resources and
political commitments over the last decade have led to great progress in diagnosing and treating
people with HIV/AIDS in resource-limited settings, with an estimated 6.6 million people with

HIV/AIDS now receiving antiretroviral therapy. Death rates have begun to decline where access
to treatments is high, and new HIV infections are beginning to stabilize in epidemic areas.
Governments at the United Nations High Level Meeting on HIV/AIDS in June 2011 committed
to ensuring ART for 15 million people with HIV/AIDS by 2015. However, there are still 10
million people in need of treatment today who are going without, and an even more pronounced
treatment gap for children less than one-third of children who need ART are currently
receiving

it.

Africa accounts for 86% of children living with HIV, 82% of AIDS-related deaths, and 91% of
new infections in children. If Millennium Development Goals 4 and 6 (achieving a two-thirds
reduction in mortality rates among children under 5 by 2015 and halting and beginning to reverse
the HIV/AIDS epidemic), and other targets are to be achieved, the high mortality rate associated
with pediatric HIV infection must be further brought under control.