Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges.
Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges.
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DOI：
10.1016/s1473-3099(13)70363-3
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发表时间：
2014-07
影响因子：
56.3
通讯作者：
Ferrand, Rashida A.
中科院分区：
文献类型：
--
作者：
Lowenthal, Elizabeth D.;Bakeera-Kitaka, Sabrina;Marukutira, Taftreyi;Chapman, Jennifer;Goldrath, Kathryn;Ferrand, Rashida A.
全球有超过 300 万儿童感染艾滋病毒，其中 90% 生活在撒哈拉以南非洲地区。随着艾滋病毒流行的成熟和抗逆转录病毒治疗的扩大，大量感染艾滋病毒的儿童正在进入青春期。该地区围产期感染艾滋病毒的青少年人数不断增加，这不仅带来了前所未有的挑战，也为了解艾滋病毒感染的发病机制提供了机会。在这篇综述中，我们讨论了儿童艾滋病毒流行病学的变化以及撒哈拉以南非洲青少年艾滋病毒感染的特殊特征。当免疫系统未发育成熟时，长期感染艾滋病毒会导致独特的慢性临床并发症，从而导致严重的发病率。除了应对慢性疾病外，感染艾滋病毒的青少年还必须面对心理社会问题，坚持服药，并学会协商性关系，同时经历快速的身心发展。需要制定针对具体情况的战略，以便及早识别儿童艾滋病毒感染并迅速与护理联系起来。临床艾滋病毒护理应整合适合年龄的性健康和生殖健康以及心理、教育和社会服务。卫生保健工作者需要接受培训，以认识和管理这些年轻人的需求，以便越来越多的存活到青春期的儿童能够在低水平卫生保健机构的专业服务之外获得优质护理。
Worldwide, more than three million children are infected with HIV, 90% of whom live in sub-Saharan Africa. As the HIV epidemic matures and antiretroviral treatment is scaled up, children with HIV are reaching adolescence in large numbers. The growing population of adolescents with perinatally acquired HIV infection living within this region presents not only unprecedented challenges but also opportunities to learn about the pathogenesis of HIV infection. In this Review, we discuss the changing epidemiology of paediatric HIV and the particular features of HIV infection in adolescents in sub-Saharan Africa. Longstanding HIV infection acquired when the immune system is not developed results in distinctive chronic clinical complications that cause severe morbidity. As well as dealing with chronic illness, HIV-infected adolescents have to confront psychosocial issues, maintain adherence to drugs, and learn to negotiate sexual relationships, while undergoing rapid physical and psychological development. Context-specific strategies for early identification of HIV infection in children and prompt linkage to care need to be developed. Clinical HIV care should integrate age-appropriate sexual and reproductive health and psychological, educational, and social services. Health-care workers will need to be trained to recognise and manage the needs of these young people so that the increasing numbers of children surviving to adolescence can access quality care beyond specialist services at low-level health-care facilities.