Vertically acquired paediatric HIV infection: the challenges of providing comprehensive packages of care in resource-limited settings

The successes achieved in paediatric disease management in well-resourced countries in recent years highlight the vast divide between the care options, and ultimately survival, between developed and developing areas of the world. Using an extensive literature review, we quantify recent achievements in terms of improved survival and quality of life, and examine current evidence of the effects of treatment on the survival and morbidity of HIV-infected children in developing countries. When provided with the same care as their counterparts in developed countries, children in developing countries show similar improvements in survival and general health, with 1-year survival rates exceeding 90% in many African settings. Despite the challenges of providing comprehensive packages of care in resource-limited settings, there is an urgent need to scale up prevention and treatment of HIV infections in children, focussing on strengthening Prevention of Mother-to-Child Transmission programmes in order to reduce the numbers of infants who are infected in addition to reducing morbidity and mortality among their mothers.