Paediatric care and treatment

HIV burden in children

Fast fact:

• Of the estimated 1.68 million [confidence bounds: 1.35 million–2.08 million] children under 15 years of age living with HIV, 88 per cent live in sub-Saharan Africa.

In 2021, 62 per cent [52–80] of the estimated infants exposed to HIV were tested for HIV within two months of birth globally while in the UNICEF’s Strategic Plan HIV priority countries, this figure was a bit higher at 64 per cent [54–83 per cent]. International guidelines advise that immediate antiretroviral therapy is crucial if HIV infection is detected in any child under the age 5 years. In reality, most children entering treatment programmes are older, with only 30 per cent of all children under 15 years of age on antiretroviral therapy being under the age of 5 years in 2021.

In 2021, an estimated 98,000 [67,000–140,000] children under age 15 died of AIDS-related causes globally. The vast majority of these deaths were preventable, either through antibiotic treatment of opportunistic infections and/or through antiretroviral treatment. About 80 per cent of these AIDS-related deaths occurred in the 35 HIV priority countries[1].

There has been some progress in antiretroviral coverage for children living with HIV

Fast facts:

• In 2021, about 878,000 children under age 15 were receiving antiretroviral therapy (ART) globally, up from about 441,000 in 2010. However, it is worth noting that the number of children under age 15 accessing ART declined by 46,000 between 2020 and 2021.
• This means that just over half of children under the age of 15 living with HIV are receiving ART (52 [42–65] per cent).

In 2021, coverage of eligible children under age 15 receiving ART varied widely, ranging from under 7 per cent in some countries to over 95 per cent in others. Regionally, coverage of ART for children ranged from 35 [28–41] per cent in West and Central Africa to 92 [74–>95] per cent in South Asia. Coverage data for Eastern Europe and Central Asia, North America and Western Europe are not available.

Despite some progress in antiretroviral therapy coverage for children living with HIV, there are alarming proportions of children who do not know their HIV status and are therefore being left behind in the response. Globally, more than 40 per cent of children living with HIV do not know their status, with the lowest proportion of knowledge of status being 35 per cent in West and Central Africa and the highest being 93 per cent in South Asia.

Even among those children who know their HIV status, concerning proportions of children are either not on ART or on ART and not virally suppressed. Concerted efforts are needed to ensure that these children are not being left behind and being linked to care.

Early diagnosis and timely initiation of treatment are particularly critical in the case of infants. The ‘Children with HIV Early Antiretroviral Therapy’ study from South Africa demonstrated a 76 per cent reduction in mortality when treatment is initiated in the first 12 weeks of life among infants who test positive for HIV.

Countries have made some progress in expanding access to early infant HIV-testing services, but testing rates are still low. WHO’s revised treatment guidelines recommend that infants, if HIV-exposed, should be tested by 4 to 6 weeks and 9 months of age using virologic assay, and when the child stops breastfeeding with a rapid antibody test. Those found positive should be started on antiretroviral therapy immediately upon diagnosis.

With progress in expanding access to early infant HIV-testing services and antiretroviral treatment for children, we are seeing these children surviving and aging out of childhood into adolescence. In 2021, nearly 140,000 children aged out at age 15 globally – 86 per cent of which were in the 35 UNICEF HIV priority countries. More than 65 per cent of these children aging out at age 15 are found in high burden regions of Eastern and Southern Africa, followed by 20 per cent in West and Central Africa. However, the gains that were made in the early 2000s have begun to plateau in recent years.

 

[1] 35 HIV priority countries: Angola, Botswana, Brazil, Burundi, Côte d’Ivoire, Cameroon, Chad, China, Democratic Republic of the Congo, Djibouti, Dominican Republic, Eswatini, Ethiopia, Ghana, Haiti, India, Indonesia, Iran (Islamic Republic of), Kenya, Lesotho, Malawi, Mozambique, Myanmar, Namibia, Nigeria, Philippines, Rwanda, South Africa, Thailand, Uganda, Ukraine, United Republic of Tanzania, Uzbekistan, Zambia, Zimbabwe.