HIV develops rapidly among children, and without treatment a third of infected children will die before age one. 280 000 children are reported to have died of AIDS in 2008 which could have been prevented if they were diagnosed earlier and treated accordingly.

Even though the number of children that are being treated with antiretroviral therapy has increased, 40% of children worldwide still do not have access to the drug. ARVs are still the most effective treatment for children with HIV, but several drugs are required to be taken everyday for the rest of the child’s life.

The treatment reduces illness and mortality. Treating children involves three stages – finding the child, testing him/her and treating them accordingly. They need to be tested as soon as possible, as early as birth, as most children with HIV contract the virus from their mothers through birth. If they are only diagnosed when they are already ill, it may be too late for any treatment to be effective.

There has always been a debate about when is too early to start treatment in children. The immediate benefits of ARVs also stand in contradiction to the long-term resistance children might build up, as they are using the drugs from a very young age. There could also be unknown side-effects if the treatment is started too early.

It is not very easy to judge the health of a baby or infant based on their CD4 count, because young children tend to have higher CD4 counts than adults. Viral load testing should be used together with CD4 count testing methods in order to choose the right treatment for the child. Until recently it was agreed that children aged 0 to 18 months with a CD4 count percentage below 20-25% should start ARV treatment regardless of whether symptoms are present, but the World Health Organisation recommends that all children under two years-old should receive the treatment regardless of their immunity.

At least three drugs are recommended for children because it prevents the child from building up a resistance against the drugs. Many factors influence the choice of drugs for children, and the medication the mother of the child used and breastfeeding should also be considered. According to Avert.com “The dose of antiretroviral drugs given to children is generally based on either weight or body surface area. Children have traditionally been thought of as being ‘mini adults’ but this is not the case. Children’s bodies are constantly changing and developing and often it is vital that drug doses are altered to ensure that a child is not given too much, or too little, of a drug.”

Side-effects can occur at various stages of a child’s course of treatment, and may be acute, sub-acute or late. It can be difficult to establish the cause of complications, so care should be taken to explore other possible causes of illnesses before it is concluded that they are a result of ARVs. The impact of side-effects may vary from mild to severe and life-threatening. Some moderate or severe side-effects may require drug substitution, or even the discontinuation of treatment. In general, mild side-effects do not require such changes and symptomatic treatment for them may be given. If side-effects are regarded as life-threatening, all ARVs should be stopped until the child has stabilized.

Children on HIV treatment need to take ARVs every day for the rest of their lives. If the drugs are not taken routinely at around the same time every day, their HIV may become resistant to the therapy, causing it to stop working.

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