Are we there yet? 40 years of successes and challenges for children and adolescents living with HIV

Abstract

Forty years ago, the first adult HIV cases were published, with infant cases following within a year [1]. As a few of these then-babies approach their 40th birthdays, both their growth and science’s growth tell dramatic stories. Antiretroviral ther apy (ART) transformed HIV from a deadly infection into a chronic disease. Just as miraculous, an AIDS-free generation became imaginable, using ART to prevent >95% of perinatal transmission. While these advances in HIV prevention and treatment deserve celebration, attention should be devoted to remaining hurdles – such as behavioural, social viral suppres sion and drug resistance challenges – that must still be over come to ensure successful life-long outcomes for the global population of children and adolescents who have grown up with HIV (CAWH). The global HIV impact for CAWH continues to be enor mous: in 2020, 1.8 million children under 14 live with HIV, and every day 400 still acquire HIV and 270 die from it. Although ART access has expanded, only 53% of CAWH were receiving ART in 2019. Many countries do not screen mothers or infants for HIV, which leads to perinatal trans mission, late childhood diagnosis, and deaths. Two million adolescents live with HIV globally, approximately 80% in sub-Saharan Africa, for whom HIV remains the top cause of death. Older adolescents (15 to 19 years) are the only age group in which HIV-related deaths are not decreasing. In the face of these young deaths, current care models clearly are not working; of adolescents 10 to 19 years with HIV, only 43% engage in care, 31% are retained in care and a dismal 30% are virally suppressed [2]. Added challenges of COVID-19 pandemic-related disruptions on HIV testing and care remain to be fully quantified and understood for CAWH