The results of the HIV Prevention Trials Network 052 (ClinicalTrials.gov number, NCT00074581) study were released this past May, 30 years after the first publication about U.S. cases of what would come to be called AIDS. The new study's stunning results — earlier treatment of human immunodeficiency virus (HIV) infection leads to a 96% reduction in the risk of HIV transmission within sero-discordant couples — will influence guidelines in the direction of even earlier initiation of anti-retroviral therapy. The notions of “test and treat” and “treatment as prevention” come as no surprise to anyone who has been involved in the fields of prevention of mother-to-child transmission of HIV and paediatric HIV care. This paper discusses the state of treatment options for children with HIV in low- and middle-income countries, including the barriers to prevention, such as low antenatal care attendance particularly in rural areas; lack of access HIV testing for most pregnant women; insufficient access to optimal anti-retroviral prophylaxis or therapy; and uncommon alternatives to breast-feeding. It also discusses the involvement of the Drugs for Neglected Diseases initiative (DNDi) on the prevention and the fight against HIV infection in children in low- and middle-income countries.
Lallemant, M.; Chang, S.; Cohen, R.; Pecoul, B. Pediatric HIV— A Neglected Disease? New England Journal of Medicine (2011) 365 (7) 581-583.