The paediatric HIV pandemic has changed from when researchers first began investigating HIV in children to where we stand today.
The burden of perinatal infections, however, remains high. Perinatal infections occur when a pregnant person living with HIV passes HIV to her baby either during pregnancy, delivery or through breastfeeding. Despite unprecedented advances in the prevention of perinatal infections (including those occurring through breastfeeding) utilizing maternal ART and infant post- exposure preventative treatment, new infections continue. An estimated 1.8 million children under 15 years of age are living with HIV-1 globally, and 5 million survive to become adolescents and young adults with perinatal infection. In addition, around 150,000 children are born with HIV-1 annually, with about half of new infections occurring before and during birth and half through breastfeeding. The COVID-19 pandemic, through disruption of clinical care and its economic impact, increased these numbers in 2021 and beyond.
A multidisciplinary, multicultural approach to combat pediatric HIV-1 infection and discover immunotherapeutic strategies towards HIV remission, has been catalyzed by the EPIICAL consortium. The EPIICAL group of investigators and clinicians, through a number of virological and immunological studies conducted both in European HIV infected cohorts as well as in HIV positive African children, has gathered further evidence of efficacy of early therapy to reduce the amount of the virus within individuals and boost of specific immune responses. These studies will pave the way for further therapeutic strategies towards HIV remission using immunotherapeutic approaches.
From the clinical perspective, adherence in mother and child are strongly associated with achieving any therapeutic success. Barriers to the mother taking her therapy often mean that the child will also not be protected! But the mothers, if given the opportunity, do an amazing job at administering therapy to their children. It takes a community of people working together to achieve the results we are looking for and the work of social scientists plays a crucial role in identifying interventions that address non-adherence in mothers and children.
Holly Peay, senior Research Scientist at RTI International and EARTH social and behavioural study lead in EPIICAL, states that “Young children with HIV cannot control their own adherence. It is important to understand attitudes and barriers to adherence experienced by caregivers of children with HIV. That allows us to choose interventions that are targeted to the problems that caregivers experience and gives us hope that improving adherence in children will also improve adherence in their mothers and other HIV positive caregivers.”
The bottom line is, testing should never be delayed and early intervention can save the lives of both mother and the young child because when the mother is suppressed, the child is also likely to be suppressed.
Visit the EPIICAL website to learn more about the project.