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The death of a 10-year-old child ‘SP’ in 2008, whose HIV infection was diagnosed only hours before death despite both parents being engaged in HIV care, prompted the British HIV Association, the Children’s HIV Association and the British Association for Sexual Health and HIV to organise a multidisciplinary conference titled ‘Don’t forget the children’ which took place later that year.1 The conference consensus document acknowledged a lack of robust protocols to identify and test children and recommended that ‘the HIV status of all the children of known HIV-positive adults in the UK be known as a matter of clinical urgency’.
UNAIDS estimates that 240 000 children were newly infected with HIV in 2013, contributing to a global total of 3 200 000 children under 14 years living with the infection.2 The overwhelming majority of these children acquired their infection vertically and are living in sub-Saharan Africa.
Without antiretroviral therapy (ART), most HIV-infected children die before their fifth birthday. Early HIV diagnosis is therefore critical, particularly in those aged under 2 years where starting ART may prevent up to 50% of deaths.3 Despite significant improvements in testing adults, only 35% of babies born to HIV-infected mothers worldwide are tested for HIV within 2 months of birth, resulting in many potentially preventable deaths.4 A small proportion of vertically infected children remain well into adolescence and are at risk of horizontally transmitting HIV if diagnosis takes place after sexual debut.5
A community based study in South Africa found that fewer than 41% of 244 surviving …
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