Pediatric HIV Treatment Strategies

在世界范围内，有100多万儿童感染艾滋病毒。41 2000年底，泰国公共卫生部报告了20,052例艾滋病毒携带者和2,332例艾滋病儿童，以及4,185名新感染的儿童--高效抗逆转录病毒疗法(HAART)的使用大大降低了成人和儿童艾滋病毒感染者的发病率和死亡率。然而，很少有儿童能够获得艾滋病毒疾病的治疗和护理，只有不到1%的儿童接受有效的抗逆转录病毒疗法。 这项研究对资源丰富和资源有限的settin.qs的适用性 在资源有限的国家，如泰国，根据国际和国家指南无法负担得起艾滋病毒感染儿童的抗逆转录病毒治疗，需要建立机制来选择接受抗逆转录病毒治疗的儿童群体。 在资源丰富的国家，大多数儿童都可以获得护理，如果比需要更早开始抗逆转录病毒治疗，可能会导致不必要的发病率。一旦开始接受抗逆转录病毒治疗，儿童将致力于终身治疗。ARV疗法的使用可能与显著的发病率有关，即毒性和病毒学耐药性的产生。脂营养不良、血脂异常和糖尿病都是可能导致的副作用 454647人健康状况和生活质量不佳。乳酸酸中毒和线粒体毒性是潜在的危及生命的副作用4649成功的儿童抗逆转录病毒治疗需要高水平的依从性，这并不是一项容易的任务，而且可能对家庭和儿童本身造成压力。因此，由于目前还没有治愈艾滋病毒感染的方法，必须在治疗疾病和保持良好的健康和生活质量之间仔细权衡。 我们认为，对于资源丰富和资源有限的环境，都需要对启动ARV治疗的适当时间进行评估。必须评估延期ARV治疗的治疗策略。

Worldwide, there are over one million children with HIV infection. 41At year-end 2000, the Thai Ministry of Public Health (MOPH) reported 20,052 and 2, 332 cases of children living with HIV and AIDS respectively, and 4,185 newly infected childrenC-The use of highly active antiretroviral therapy (HAART) has resulted in a significant reduction of morbidity and mortality among adults and children with HIV infection. 4344Nevertheless, few children have access to treatment and care for HIV disease, and less than 1% of children are on effective ARV therapy. Applicability of this study to both resource-rich and resource-limited settin.qs In resource-limited countries such as Thailand where ARV treatment for HIV-infected children according to international and national guidelines is not affordable, mechanisms for selecting groups of children to receive ARV treatment are needed. In resource-rich countries where the majority of children have access to care, the initiation of ARV therapy, if sooner than needed, can result in unnecessary morbidity. Once begun on ARV therapy, children are committed to life-long treatment. The use of ARV therapy can be associated with significant morbidity, namely toxicity and development of virological resistance. Lipodystrophy, dyslipidaemia and diabetes mellitus are examples of side effects that can result 45 4647 in poor health and quality of life. Lactic acidosis and mitochondrial toxicity are potentially life-threatening side effects 4649Successful treatment with ARV in children requires high-level compliance, which is not an easy task, and can be stressful for families and the children themselves.so As there is currently no cure for HIV infection, a balance between treating the disease and maintaining good health and quality of life must be weighed carefully. We believe that for both resource-rich and resource-limited settings, an evaluation of the appropriate time of initiation of ARV therapy is needed. The treatment strategy of deferred ARV therapy must be evaluated.