HIV infection in children in developing countries

Disease progression in children acquiring HIV infection vertically from the ir mothers is more rapid in developing countries compared with developed co untries. The probability of death by 12 months in sub-Saharan Africa ranges from 0.23 to 0.35, and by 5 years is 0.57-0.68. Data from Europe in the er a before highly active anti-retroviral therapy (HAART) yielded probabilitie s of 0.1 and 0.2, respectively. Confirming the diagnosis can be difficult i n resource-limited settings. Existing clinical case definitions are useful epidemiologically, but of low positive-predictive value in individual child ren. Priorities for research into management issues include nutrition (infa nt feeding, vitamin A and micronutrient supplementation), prophylaxis again st Pneumocystis carinii pneumonia (PCP), and bacterial infections, case man agement of persistent diarrhoea, diagnosis/prevention/management of tubercu losis in children and prevention of sexual transmission in adolescents.