HIV infection and exposure in children and adolescents 25 years of antiretroviral prophylaxis and treatment: what has been achieved?

Background Since 1997 an effective prevention and treatment of infections with human immunodeficiency virus (HIV) have been available in the form of antiretroviral combination therapy. Objective What has been achieved during this time by transmission prophylaxis and treatment of HIV infections in children in Germany? Material and methods Presentation of the development of transmission prophylaxis and the epidemiological surveys of the Robert Koch Institute, presentation of drug development and guidelines for antiretroviral therapy in children and adolescents and presentation of surveys of the German pediatric and adolescent HIV cohort (GEPIC). Results The introduction of HIV testing of pregnant women has made regular antiretroviral treatment of HIV positive pregnant women and the introduction of transmission-reducing measures possible. This has reduced the risk of vertical transmission from about 30% to < 1%. Currently, it is being investigated whether children exposed to HIV can be breastfed without risk. Antiretroviral therapy in children has decisively improved the survival rates and the physical and cognitive development of HIV positive children. New active substances have a more favorable side effect profile. In Germany, the World Health Organization (WHO) target of achieving complete suppression of the viral load in 90% of the children has been achieved. A delayed diagnosis in children and adolescents is still associated with severe infections. An HIV infection remains a disease with a stigma and is therefore usually kept secret from the children and their environment. Conclusion With the transmission prophylaxis and therapy that are now available, it is possible to prevent transmission to a large extent and with a timely diagnosis to enable HIV positive children to lead a largely healthy life. The goal of children being able to know and name their disease without fear has still not been achieved.