Being Born and Growing Up with HIV

Photo: ISGlobal. Argencia, seven months old, lives in Manhiça (Mozambique) and has HIV. Twice a day she takes her treatment, which barely fits in her hand.

[This article has been published originally in Spanish in El País Planeta Futuro]

Almost two million children under 15 years of age live with human immunodeficiency virus (HIV), most of them in sub-Saharan Africa. The virus can be transmitted from a mother to her child (a phenomenon known as vertical transmission) during pregnancy, at birth or through breastfeeding. When no steps are taken to prevent it, mother-to-child transmission occurs in between 15% and 45% of cases. However, the risk can be reduced to 5% or less by interventions that include treating the mother or administering preventive doses of antiretroviral drugs to the newborn infant.

To eliminate new HIV infections among children and adolescents and to ensure access to antiretroviral therapy for young people living with the infection, UNAIDS launched a framework called Start Free, Stay Free, AIDS Free. This initiative focuses on enhancing action in the 23 countries that account for 85% of the pregnant women, children and adolescents living with HIV worldwide.

Almost two million children under 15 years of age live with human immunodeficiency virus (HIV), most of them in sub-Saharan Africa

Between 2010 and 2018, the number of new childhood infections in these 23 countries was reduced from 240,000 to 130,000. Despite this achievement, the target of reducing the annual number of new infections in children to under 20,000 by 2020 is still a long way off and progress is uneven: in 2018, half of the new childhood infections were concentrated in just six countries (Kenya, Mozambique, Nigeria, Tanzania, South Africa and Uganda).

A drawing made by a child in Manhiça (Mozambique) on occasion of World AIDS Day.

Prevention. Every child has the right to be born free from HIV

To reduce vertical transmission, we must improve diagnosis, ensure early treatment for pregnant and breastfeeding women and optimize adherence among women in treatment.

Another vital step is to translate international recommendations for prevention into strategies that can be applied in the countries with a higher prevalence of HIV infection. For example, pre-exposure prophylaxis (or PrEP)—an intervention recommended by the World Health Organization (WHO) for HIV-seronegative women who are pregnant or breastfeeding—has not, to date, been widely implemented.

To reduce vertical transmission, we must improve diagnosis, ensure early treatment for pregnant and breastfeeding women and optimize adherence among women in treatment

Furthermore, it has recently become clear that additional scientific evidence is needed to support the hypothesis that HIV-seropositive mothers in whom the virus in blood (viral load) is undetectable are not at risk of transmitting the virus to their children during breastfeeding. In other words, confirmation is needed that the premise 'Undetectable=Untransmittable' can be extrapolated to breastfeeding. Greater certainty in this respect would allow all the women who live with HIV to make a personal decision about whether or not they want to nurse their child in the knowledge that breastfeeding is safe and would not increase the risk of transmitting the virus to their child.

A drawing made by a child in Manhiça (Mozambique) on occasion of World AIDS Day.

Treatment. Much work still needs to be done to simplify paediatric antiretroviral therapy

Antiretroviral therapy has transformed the course of HIV infection. Today, most of those infected can maintain the viral load at undetectable levels, live healthy lives and do not risk transmitting the infection to others. However, infected children must be started on treatment as early as possible and must take the drugs every day of their lives.

The problem is that the treatment regimens are still complex and poorly adapted to use in infants and children. The tablets are difficult to swallow and syrup formulations must be stored in a refrigerator, an unattainable luxury in many countries. While the granules of the drug can be extracted from capsules and administered to infants with milk or food, the unpleasant taste of the medicine makes administration difficult, particularly during the early months of life before the infant starts to eat solid foods.

The problem is that the treatment regimens are still complex and poorly adapted to use in infants and children

One of the many children with this problem is Argencia, a little girl who lives in Manhiça, a rural community in Mozambique. At only seven months, she has to take her antiretroviral medication twice a day and, as you can see in the picture, the dose hardly fits in her hand.

There are promising indications that new antiretroviral drugs which require administration only once a month or even less frequently can be adapted for children in the near future—an advance likely to facilitate adherence and improve the quality of life of children living with HIV.

Cure. A distant but hopeful future

A woman who attended the Manhiça hospital has tested negative for AIDS.

Antiretroviral therapy has been and still is the cornerstone of progress in the response to HIV. However, lifelong antiretroviral therapy is associated with many challenges, including long-term adherence, toxicity, frequent hospital visits, and so on. Drug resistance is also a major problem and around half of the infants under 18 months diagnosed with HIV are infected with strains that are drug-resistant even before treatment is started.

There is still no cure for HIV: once a person has been infected with the virus we have no way of eliminating it completely. However, there is now a growing interest in lines of research directed at finding a cure for the infection or, alternative, enabling patients with HIV to live healthily without continuous medication, that is, to achieve what is called "remission" of the disease. New strategies, including the intravenous or subcutaneous administration of antibodies, have been shown in adults to control the infection for some months without antiretroviral treatment, which is an encouraging finding.

We are all part of the community that must continue to make a difference in the fight against HIV

The theme for this year's World AIDS Day is ‘Communities make the difference’. This recognises the vital role played by communities in the fight against HIV. Communities ensure that the response remains relevant and grounded and that no one is left behind.

And we should not forget that these communities are not only made up of people living with HIV. Health workers, scientists, governments, international organisations, the private sector, educators, leaders from all walks of life—we are all part of the community that must continue to make a difference in the fight against HIV.