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The hard part we often forget: providing care to children and adolescents with advanced HIV disease

Frigati, Lisa Jane; Gibb, Diana; Harwell, Joseph; Kose, Judith; Musiime, Victor; Rabie, Helena; Rangaraj, Ajay; ... Penazzato, Martina; + view all (2023) The hard part we often forget: providing care to children and adolescents with advanced HIV disease. Journal of the International AIDS Society , 26 (3) , Article e26041. 10.1002/jia2.26041. Green open access

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Abstract

INTRODUCTION: Many children and adolescents living with HIV still present with severe immunosuppression with morbidity and mortality remaining high in those starting antiretroviral therapy (ART) when hospitalized. DISCUSSION: The major causes of morbidity and mortality in children living with HIV are pneumonia, tuberculosis, bloodstream infections, diarrhoeal disease and severe acute malnutrition. In contrast to adults, cryptococcal meningitis is rare in children under 5 years of age but increases in adolescence. In 2021, the World Health Organizations (WHO) consolidated guidelines for managing HIV disease and rapid ART included recommendations for children and adolescents. In addition, a WHO technical brief released in 2020 highlighted the various interventions that are specifically related to children and adolescents with advanced HIV disease (AHD). We discuss the common clinical presentations of children and adolescents with AHD with a focus on diagnosis, prevention and treatment, highlight some of the challenges in the implementation of the existing package of care, and emphasize the importance of additional research to address the needs of children and adolescents with AHD. CONCLUSIONS: There are limited data informing these recommendations and an urgent need for further research on how to implement optimal strategies to ensure tailored approaches to prevent and treat AHD in children and adolescents. Holistic care that goes beyond a simple choice of ART regimen should be provided to all children and adolescents with AHD.

Type: Article
Title: The hard part we often forget: providing care to children and adolescents with advanced HIV disease
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/jia2.26041
Publisher version: https://doi.org/10.1002/jia2.26041
Language: English
Additional information: © 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: Adolescents; advanced HIV disease; children; co-infections; prevention; treatment
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10167010
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