1. Anti-retroviral therapy in HIV+-
pregnant women & children
Zeena Nackerdien

2. Mother-to-child transmissions &
pediatric HIV data worldwide (1-3)
* 21 countries; eART, effective anti-retroviral therapies; MTCT, mother-to-child transmission
1. World Health Organization. HIV/AIDS fact sheet no. 360 (Updated October 2013) [cited 2014 May]. http://www.who.int/mediacentre/factsheets/fs360/en/
2. World Health Organization. Pediatric HIV data and statistics (2011) [cited 2014 May]. http://www.who.int/hiv/topics/paediatric/data/en/index1.html.
3. Amfar. Statistics: Worldwide 2013 [cited 2014 May]. http://www.amfar.org/about-hiv-and-aids/facts-and-stats/statistics--worldwide/
Worldwide, treatment-
naïve MTCT
transmission rates:
15-45%
3.3 million
children have HIV/AIDS
In 2012, 62% of ~1.5 million
HIV+-pregnant
women received eARTs
to avoid MTCTs vs 48% in 2010
ARTs among children (0-14 y)
• Receiving ART (Total): 566,000
• North-Africa/Middle East: 900
• Eastern & Southern Africa:426,800
• Needing ART (Total): 1,990,000
• ART coverage (Total): 28%
~260,000 children newly
HIV+ in 2012
88% of world’s HIV+-children
live in sub-Saharan Africa*

3. ART guide/public health
progress (4-5)
New HIV+-infections among children:
Slow (<30%) to rapid decline
(50%) in 10 high-burden countries
↓37% in 21 countries
Other milestones
• New WHO guidelines for PrEP & ARTs aim
to ↑women & children receiving HIV
treatment, among other goals
• All priority countries phased out single-
dose nevirapine prophylaxis in favor of
more effective ARTs for women & children
ART, antiretroviral therapy; cART, combined ART; PrEP, pre-exposure prophylaxis; WHO, World Health Organization
4. AIDSinfo (National Institute of Health) Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and
interventions to reduce perinatal HIV transmission in the United States 2014 http://aidsinfo.nih.gov/contentfiles/lvguidelines/Peri_Recommendations.pdf.
5. UNAIDS. 2013 Progress report towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive
http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2013/20130625_progress_global_plan_en.pdf.

4. 2014 Pediatric ART guidelines(6)
Age-appropriate diagnostic tests/ongoing monitoring of ART-naïve & treated HIV+-
infants/children
Treatment
When to start
• HIV-infected children ( ≥1 year) with confirmed plasma HIV RNA levels >100,000
copies/mL
• cART should be started in HIV-infected infants aged <12 months, regardless of other
diagnostic criteria
• Age-appropriate cART should be started in HIV-infected children aged ≥1 year who
are asymptomatic or have mild symptoms and pre-specified CD4 cell counts
• cART should be started in all children with AIDS or significant symptoms
What to start
• Individualized regiments proposed based on clinical features & results of viral
resistance testing
• Age-appropriate cART in treatment-naïve children should consist of preferred agents
plus a dual NRTI-backbone
• Strategies to maximize adherence when starting or switching cART should be
implemented
• Medication toxicities or intolerance should be managed
cART, combined antiretroviral therapy; NRTI, nucleoside/nucleotide reverse transcriptase inhibitor
6. AIDSinfo (NIH) Guidelines for the use of antiretroviral agents in pediatric HIV infection 2014
http://m.aidsinfo.nih.gov/contentfiles/lvguidelines/PedARV_RecsOnly.pdf.
Issues in HIV+-
adolescents: complex
cART dosing, puberty,
contraceptives, transition
to adult settings