59% of children suffering from severe immunodeficiency at treatment initiation

06 October 2014

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Two thirds of children from low and middle-income countries are presented for HIV treatment with severe immunodeficiency, a new study has revealed. Current WHO guidelines recommend that treatment is available for all HIV positive children under the age of five, regardless of their CD4 count, in order to curb the epidemic among younger generations. These updated guidelines have led to a profound increase in children receiving treatment, with over 740,000 children in 2013 on highly active antiretroviral treatment (HAART). Despite this increase in treatment access, the high numbers of children commencing treatment with severely low CD4 levels remains high for many countries.

The study included 34,706 children under the age of 16 from 11 different countries. The findings reveal declines in severe immunodeficiency for children across all countries, with the greatest declines observed in high-income countries. Despite this progress, severe immunodeficiency among children at treatment initiation remains high. 59 percent of children in the study were presented for treatment with severe immunodeficiency. The issue was greatest in low and middle-income countries, with 63 percent of children suffering from severe immunodeficiency. For high-income countries this percentage was significantly smaller, with 19 percent of children exhibiting severely low CD4 levels at treatment initiation. Weak country level implementation of the WHO guidelines, limited HAART availability for young people and poor infant diagnosis have been highlighted as factors that have led to high levels of severe immunodeficiency among children at treatment initiation.

Severe immunodeficiency among children and young people at treatment initiation requires urgent attention if HIV and AIDS mortality rates are to be reduced. With recent research highlighting that AIDS mortality rates are rising among adolescents, whilst declining for all other age groups, addressing the severely low CD4 levels at treatment initiation is critical to reduce these rates. WHO guidelines are ultimately enabling children to have greater access to treatment but without addressing country- level service delivery issues, putting these guidelines into practice will remain problematic.

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