HIV infection in children

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The results of good research are also making a real difference to children infected with HIV (human immunodeficiency virus), the cause of AIDS.

At the end of 2009, figures from UNAIDS (the joint United Nations Programme on HIV/AIDS) show that an estimated 2.5 million children were living with HIV around the world, 2.3 million of them in sub-Saharan Africa. Every hour, around 30 children were dying as a result of AIDS. [6] Bacterial infections, such as pneumonia, which are associated with the children’s weakened immune system, are a common cause of death.

Co-trimoxazole is a widely available, low-cost antibiotic that has been used for many years to treat children and adults with chest infections unrelated to AIDS. Studies in adults with HIV additionally showed that the drug reduces other complications from bacterial infections. [7]

When preliminary evidence showed that the infections in children with HIV might also be reduced, a group of British researchers got together with colleagues in Zambia to assess the effects of co-trimoxazole as a possible preventive medicine in a large study.

The trial, which started in 2001 and lasted about two years, compared the antibiotic with a placebo in over 500 children. The results became clear sooner than anticipated when it was shown that the drug cut AIDS-related deaths by 43% (74 deaths in the co-trimoxazole group compared with 112 in the placebo group) and also reduced the need for hospital admissions. At this point the independent committee scrutinizing the results recommended that the trial be stopped.

One immediate outcome was that all children in the trial were given co-trimoxazole as part of a Zambian government initiative. A wider consequence was that the World Health Organization and UNICEF promptly altered their advice on medicines for children with HIV.[8, 9] These organizations continue to recommend co-trimoxazole as an inexpensive, life-saving and safe treatment for such children. [10]