Abstract:
Introduction: As highly active antiretroviral therapy (HAART) transforms human immunodeficiency virus (HIV) into a manageable
chronic disease, new challenges are emerging in treating children born with HIV, including a number of risks to their physical and
psychological health due to HIV infection and its lifelong treatment.
Methods: We conducted a literature review to evaluate the evidence on the physical and psychological effects of perinatal HIV
(PHIV ) infection and its treatment in the era of HAART, including major chronic comorbidities.
Results and discussion: Perinatally infected children face concerning levels of treatment failure and drug resistance, which may
hamper their long-term treatment and result in more significant comorbidities. Physical complications from PHIV infection
and treatment potentially affect all major organ systems. Although treatment with antiretroviral (ARV) therapy has reduced
incidence of severe neurocognitive diseases like HIV encephalopathy, perinatally infected children may experience less severe
neurocognitive complications related to HIV disease and ARV neurotoxicity. Major metabolic complications include dyslipidaemia
and insulin resistance, complications that are associated with both HIV infection and several ARV agents and may significantly
affect cardiovascular disease risk with age. Bone abnormalities, particularly amongst children treated with tenofovir, are a
concern for perinatally infected children who may be at higher risk for bone fractures and osteoporosis. In many studies, rates of
anaemia are significantly higher for HIV-infected children. Renal failure is a significant complication and cause of death amongst
perinatally infected children, while new data on sexual and reproductive health suggest that sexually transmitted infections and
birth complications may be additional concerns for perinatally infected children in adolescence. Finally, perinatally infected
children may face psychological challenges, including higher rates of mental health and behavioural disorders. Existing studies have significant methodological limitations, including small sample sizes, inappropriate control groups and heterogeneous
definitions, to name a few.
Conclusions: Success in treating perinatally HIV-infected children and better understanding of the physical and psychological
implications of lifelong HIV infection require that we address a new set of challenges for children. A better understanding of
these challenges will guide care providers, researchers and policymakers towards more effective HIV care management for
perinatally infected children and their transition to adulthood.