A Practical Guide to the Implementation of the 2009 World Health Organization Pediatric HIV Treatment Recommendations
Despite ongoing efforts to address the specific challenges of pediatric HIV prevention and treatment, at the end of 2008, there were an estimated 2.1 million children under the age of 15 living with HIV. Children accounted for 6 percent of all people living with HIV (PLWH), 16 percent of the people newly infected, and 14 percent of all HIV-related mortality worldwide (Joint U.N. Programme on HIV/AIDS [UNAIDS] 2009). While data show that global under-five mortality has decreased steadily over the past two decades, 8.8 million children still die before their fifth birthday each year (U.N. Children’s Fund [UNICEF] 2009), and HIV has reversed many of the gains in those countries hardest hit by the epidemic.
In April 2008, in response to the high number of infants living with HIV and severe HIV-related pediatric mortality, the World Health Organization (WHO) Technical Reference Group for Paediatric HIV/Antiretroviral Therapy (ART) and Care released a series of nine updated recommendations for diagnostic testing, initiation of treatment, and appropriate treatment regimens for HIV-exposed and -infected infants. These recommendations were revised in 2009, and additional changes were made in 2010. The latest changes to the WHO treatment guidelines are summarized below, in Table 1.
The goal of the WHO’s recommendations is to decrease mortality in infants living with HIV and universal access to prevention, care, and treatment of HIV infection in infants and children. The specific objectives are designed to provide a strategic framework focusing on 1) the appropriate time and effective technologies to identify and monitor HIV-infected or -exposed infants; 2) the right time to initiate ART; and 3) effective treatment and care regimens that save lives.