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HIV/AIDS in children, Chilean experience


Abstract

The magnitude of the problem is described worldwide and in Chile. It is highlighted that globally, measures to prevent HIV transmission in both adults and pregnant women and the growing increase in people accessing ART, HIV infection in adults, but especially in children, has been halted and even reduced. However, in Chile, in the last 10 years there has been an increase in total cases, especially in the age of procreation. Exception is infection in VT infected children that has decreased to <2%. It describes, (a) how HIV exposed/infected newborns and children already infected with HIV can be detected and which flow-chart to follow; b) HIV VTPPs components; c) how to certify HIV infection in newborns and children under 18 months of age, due to the presence of maternal passive antibodies, which may last up to 18 months, the HIV/DNA/PCR technique should be used; (d) the study/evaluation and preventive and therapeutic management of HIV-exposed newborns and already infected children. With regard to HIV infection in children and adolescents in Chile, the creation in 1990 of the Committee on Pediatric HIV/AIDS, which works together with MINSAL in the Pediatric HIV/AIDS Care Programme, stands out. The Committee consists of representatives from all regions of the country and its main objectives have been to detect for newborns/children exposed to HIV (children of HIV+ mothers) and children already infected with HIV, and to follow up (assessment/study, preventive and therapeutic management) of them up to the age of 18 years, the age at which they are transferred to the Adult HIV Programme. In Chile, the identification of HIV-infected children has been increasingly earlier in life, so has their access to ART. In the exposed newborn, the HIV/DNA/PCR technique began to be applied in 1992, lowering the HIV certification age from more than 20 months to 3 to 4 months. HIV VTPPs began to apply in 1995, down VIH VT from >35% before that year to 2% in 2005. With the promulgation of the HIV Prevention Norm by MINSAL in 2005, HIV VT has declined to <2% today. With the identification of infected children increasingly earlier in life, in less severe clinical and immunological stages, improvement in preventive and therapeutic measures, with greater access to ART, has been achieved to prolong survival and decrease lethality; 70% of children infected with HIV VT are in adolescence or adulthood, and some women have had uninfected children thanks to HIV VTPPs use.

Keywords

immunodeficiency, antiretroviral therapy, cytomegalovirus

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