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The UNAIDS Global AIDS Strategy released in 2021 places ending inequity as the top priority to end AIDS. It recognizes the importance of a rights‐based approach to address the needs [...]

: Introduction: Adolescents living with HIV (ALHIV) on antiretroviral therapy (ART) have specific health needs that can be challenging to deliver. Sub‐Saharan Africa (SSA) is home to 84% of the global population of ALHIV, of whom about 59% receive ART. Several studies in SSA have demonstrated health service gaps due to lack of synchronized healthcare for ALHIV receiving ART. We conducted a systematic review of health‐related needs among ALHIV on ART in SSA to inform decisions and policies on care. Methods: We searched MEDLINE, Web of Science, EMBASE, PsycINFO, Cochrane library and grey literature for studies reporting health‐related needs among ALHIV receiving ART in SSA, between January 2003 and May 2020. Results and discussion: Of the 2333 potentially eligible articles identified, 32 were eligible. Eligible studies were published between 2008 and 2019, in 11 countries: Zambia (7), Uganda (6), Tanzania (4), South Africa (4), Kenya (3), Ghana (2), Zimbabwe (2), Rwanda (1), Malawi (1), Botswana (1) and Democratic Republic of Congo (1). Seven categories of health needs among ALHIV were identified. In descending order of occurrence, these were: psychosocial needs (stigma reduction, disclosure and privacy support, and difficulty accepting diagnosis); dependency of care (need for family and provider support, and desire for autonomy); self‐management needs (desire for better coping strategies, medication adherence support and reduced ART side effects); non‐responsive health services (non‐adolescent friendly facility services and non‐compatible school system); need for food, financial and material support; inadequate information about HIV (desire for more knowledge to fight misinformation and misconception); and developmental and growth needs (desire to experience sex, parenthood and love). Ecological analysis identified different priority needs between ALHIV, their caregivers and healthcare providers, including psychosocial needs, financial challenges and non‐responsive health services, respectively. Conclusions: To respond effectively to the health needs of ALHIV and improve ART adherence, interventions should focus on stigma reduction, disclosure challenges and innovative coping mechanisms for ART. Interventions that address the health needs of ALHIV from the perspective of carers and providers, such as financial support schemes and adolescent‐friendly healthcare strategies, should supplement efforts to improve adolescent ART adherence outcomes., INTRODUCTION Adolescents living with HIV (ALHIV) receiving antiretroviral therapy (ART) have specific health needs that can be challenging to deliver compared with adults. Worldwide, an estimated 1.8 million adolescents (10–19 [...]

In this special issue of the Journal of the International AIDS Society, we focus on research and perspectives that put adolescents and young people at the centre of their HIV [...]

Background: With support from US President's Emergency Plan for AIDS Relief, FACT Zimbabwe is implementing Children Tariro (CT) programme to mitigate the impacts of HIV/AIDS among Zimbabwe's OVC, 0 to [...]

The Joint Learning Initiative on Children and AIDS recently recommended that programmes for children affected by HIV and AIDS in sub‐Saharan Africa direct more support to families. Interest has grown in including men in such family‐orientated interventions by researchers, policy makers, and community and non‐governmental organizations. However, there is a lack of good quality data on men's involvement with children in the diverse settings in sub‐Saharan Africa. In addition, limited research has examined their role in providing emotional, material support and protection for HIV‐ and AIDS‐affected children and families. In this paper, we describe the availability of data about men and families, in particular fathers, in ongoing sub‐Saharan African surveys and longitudinal population cohorts. We discuss the conceptual and measurement issues associated with data collection on men's involvement in these types of studies. We consider the opportunities for improving the collection of data about men and families in household surveys and population cohorts in order to inform the design and evaluation of family‐centred interventions for children affected by HIV and AIDS., Introduction The Joint Learning Initiative on Children and AIDS has recently recommended that families need to be more central in intervention programmes to support children affected by HIV and AIDS [...]

Background: Despite strong global interest in family‐centred HIV care models, no reviews exist that detail the current approaches to family‐centred care and their impact on the health of children with HIV. A systematic review of family‐centred HIV care programmes was conducted in order to describe both programme components and paediatric cohort characteristics. Methods: We searched online databases, including PubMed and the International AIDS Society abstract database, using systematic criteria. Data were extracted regarding programme setting, staffing, services available and enrolment methods, as well as cohort demographics and paediatric outcomes. Results: The search yielded 25 publications and abstracts describing 22 separate cohorts. These contained between 43 and 657 children, and varied widely in terms of staffing, services provided, enrolment methods and cohort demographics. Data on clinical outcomes was limited, but generally positive. Excellent adherence, retention in care, and low mortality and/or loss to follow up were documented. Conclusions: The family‐centred model of care addresses many needs of infected patients and other household members. Major reported obstacles involved recruiting one or more types of family members into care, early diagnosis and treatment of infected children, preventing mortality during children's first six months of highly active antiretroviral therapy, and staffing and infrastructural limitations. Recommendations include: developing interventions to enrol hard‐to‐reach populations; identifying high‐risk patients at treatment initiation and providing specialized care; and designing and implementing evidence‐based care packages. Increased research on family‐centred care, and better documentation of interventions and outcomes is also critical., Background Highly active antiretroviral therapy (HAART) has now been available for more than 10 years, profoundly changing the way we think about HIV, turning victims into survivors. Reliably robust results [...]

Study of almost half a million people links mutation that protects against HIV infection to an earlier death. Study of almost half a million people links mutation that protects against HIV infection to an earlier death., Author(s): Sara Reardon Author Affiliations: Gene edits to 'CRISPR babies' might have shortened their life expectancy Biophysicist He Jiankui helped to create the world's first gene-edited babies. [see PDF for [...]

Characterizing intraregional differences in current pediatric HIV care and treatment in Asia can guide the development of clinical practice guidelines and improve the understanding of local resource availability. The Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) Pediatric Program is a collaboration of clinics and referral hospitals studying pediatric HIV outcomes in the region. A Web-based survey to characterize clinical management practices and monitoring resources was developed and distributed to 20 sites in January 2008. Seventeen (85%) sites from 6 countries responded through April 2008; 14 (82%) were hospital-based and 16 (94%) were public facilities. Of 4050 HIV-infected children under care, 3606 (89%) were on antiretroviral treatment; 80% were on their first mono-, dual-, or triple-drug regimen and 74% were on nevirapine- or efavirenz-based regimens. Fifteen (88%) sites had consistent access to polymerase chain reaction (PCR) testing for infant diagnosis. All sites had access to CD4 testing, with 13 (76%) routinely monitoring patients every 3-6 months; 7 (41%) sites monitored viral load at 6- to 12-month intervals. Although there is some variation in clinical practices, high levels of treatment and monitoring resources were available at these sites. The availability of PCR for early infant diagnosis positions them to implement recent WHO recommendations to treat HIV-infected children younger than 1 year of age. This information will be used to develop future research and programs to support children with HIV in Asia. DOI: 10.1089/apc.2009.0224

Background: Micronutrient deficiencies compromise the survival of HIV‐infected children in low‐income countries. We assessed the effect of multiple micronutrient supplementation on the mortality of HIV‐infected children in Uganda. Methods: In a randomized, controlled trial, 847 children aged one to five years and attending HIV clinics in Uganda were stratified by antiretroviral therapy (ART, n = 85 versus no ART, n = 762). The children were randomized to six months of either: twice the recommended dietary allowance of 14 micronutrients as the intervention arm (vitamins A, B[sub.1], B[sub.2], niacin, B[sub.6], B[sub.12], C, D and E, folate, zinc, copper, iodine and selenium); or the standard recommended dietary allowance of six multivitamins (vitamins A, D[sub.2,] B[sub.1], B[sub.2], C and niacin) as a comparative “standard‐of‐care” arm. Mortality was analyzed at 12 months of follow up using Kaplan Meier curves and the log rank test. Results: Mortality at 12 months was 25 out of 426 (5.9%) children in the intervention arm and 28 out of 421 (6.7%) in the comparative arms: risk ratio 0.9 (95% CI 0.5 ‐ 1.5). Two out of 85 (2.4%) children in the ART stratum died compared with 51 out of 762 (6.7%) in the non‐ART stratum. Of those who died in the non‐ART stratum, 25 of 383 (6.5%) were in the intervention arm and 26 of 379 (6.9%) in the comparative arm; risk ratio 1.0 (95% CI 0.6 ‐ 1.6). There was no significant difference in survival at 12 months (p = 0.64, log rank test). In addition, there was no significant difference in mean weight‐for‐height at 12 months; 0.70 ± 1.43 (95% CI 0.52 ‐ 0.88) for the intervention versus 0.59 ± 1.15 (95% CI 0.45 ‐ 0.75) in the comparative arm. The mean CD4 cell count; 1024 ± 592 (95% CI 942 ‐ 1107) versus 1060 ± 553 (95% CI 985 ‐ 1136) was also similar between the two groups. Conclusions: Twice the recommended dietary allowance of 14 micronutrients compared with a standard recommended dietary allowance of six multivitamins for six months was well tolerated, but it did not significantly alter mortality, growth or CD4 counts. Future intervention studies should carefully consider: (1) the composition and dosing of the supplements; and (2) the power needed to detect a difference between arms. Trial Registration: ClinicalTrials.gov Identifier: NCT00122941, Background Mortality in HIV‐infected children living in low‐income countries is still high compared with high‐income countries [1,2]. Malnutrition in children under five years of age is highly prevalent and both [...]

This study sought to elucidate methodological issues in adherence research by comparing multiple methods of assessing adherence to antiretroviral medication. From 2003 to 2004, 24 youths with vertically infected HIV disease (mean age = 14.0 years; range, 8-18) and their caregivers participated in a 6-month study. These children were all on highly active antiretroviral therapy (HAART) and were relatively healthy (mean CD4 absolute count= 711.8 [+ or -] 604.5). Adherence was assessed with the Medication Event Monitoring System (MEMS), pill counts, and interviews. Patients and caregivers completed the Perceptions of Adherence Study Participation (PASP) questionnaire. MEMS provided the most detailed adherence information, and good reliability was indicated by significant correlations with medical markers. Pill counts provided similar adherence rates, while patients and caregivers reported nearly perfect adherence in interviews. Problems were experienced with each method: MEMS were expensive, had cap malfunctions, and lack a consistent guiding principle for data interpretation. With pill counts, families forgot to bring all medication bottles to clinic, and interviews were compromised by social desirability and difficulty reaching families by telephone. Most patients and caregivers believed study participation improved the child's adherence, although PASP ratings were unrelated to adherence at the study endpoint. While MEMS may be most reliable, pill counts offer comparable data and are less costly, while interviews seemed least accurate in this study. Most participants reported positive perceptions of their research experience. A consensus among researchers is needed for defining and measuring adherence, and specific recommendations are offered for achieving this goal.

Children with perinatally acquired HIV-1 infection are surviving into adolescence and increasingly transitioning toward adult services. Planning appropriate services in adult life requires an understanding of their progress through pediatric care. We describe the demographic features, disease progression, antiretroviral therapy (ART), and resistance in young people aged 10 years or more living in the United Kingdom and Ireland reported to the National Study of HIV in Pregnancy and Childhood (NSHPC) with prospective annual follow-up in the Collaborative HIV Paediatric Study (CHIPS) between 1996 and September 2007. Six hundred fifty-four perinatally infected young people were identified; 76% black African, 57% born abroad. Median age at presentation and duration of follow-up was 1 and 11 years, respectively, if born in the United Kingdom/Ireland, and 8 and 5 years if born elsewhere. One hundred sixty-nine (26%) ever had an AIDS-defining illness. Ten died during adolescence. At last follow-up, 64% were on ART, 18% off treatment having previously received ART and 18% were ART naive. Of 518 who had received highly active antiretroviral therapy (HAART), 47% were triple class experienced. At last follow-up 77 (12%) had CD4 counts less than 200 per microliter; of those on HAART, 78% had HW-1 RNA [less than or equal to] 400 copies per milliliter, median CD4 count 554 (interquartile range [IQR] 324-802). Among 166 with resistance assays on HAART, 52% and 12% had dual- and triple-class HIV-l-associated resistance mutations, respectively. One hundred three (16%) young people had transferred to adult services. Young adults with perinatally acquired HIV-1 infection require coordinated multidisciplinary transitional care services and careful long-term follow-up in adult life.

Background: As highly active antiretroviral therapy (HAART) becomes increasingly available to African children, it is important to evaluate simple and feasible methods of improving adherence in order to maximize benefits of therapy. Methods: HIV‐1‐infected children initiating World Health Organization non‐nucleoside reverse transcriptase‐inhibitor‐containing first‐line HAART regimens were randomized to use medication diaries plus counselling, or counselling only (the control arm of the study). The diaries were completed daily by caregivers of children randomized to the diary and counselling arm for nine months. HIV‐1 RNA, CD4+ T cell count, and z‐scores for weight‐for‐age, height‐for‐age and weight‐for‐height were measured at a baseline and every three to six months. Self‐reported adherence was assessed by questionnaires for nine months. Results: Ninety HIV‐1‐infected children initiated HAART, and were followed for a median of 15 months (interquartile range: 2–21). Mean CD4 percentage was 17.2% in the diary arm versus 16.3% in the control arm at six months (p = 0.92), and 17.6% versus 18.9% at 15 months (p = 0.36). Virologic response with HIV‐1 RNA of Conclusion: Medication diaries did not improve clinical and virologic response to HAART over a 15‐month period. Children had good adherence and clinical response without additional interventions. This suggests that paediatric HAART with conventional counselling can be a successful approach. Further studies on targeted approaches for non‐adherent children will be important., Introduction As highly active antiretroviral therapy (HAART) becomes increasingly available to African children, a key priority is to achieve and sustain high levels of adherence in order to prevent the [...]

Problem In 2003, the goal of the Kenyan Ministry of Health was to avail antiretroviral treatment (ART) to 50% of the estimated 250 000 eligible individuals by the end of 2005. By July 2005, 45 000 adults and more than 2000 children were on treatment. A study was conducted to determine the barriers to identification of HIV-infected children. Approach Existing government policies were reviewed and the ART register of the Kenya National AIDS Control Programme was used to identify facilities providing ART. This paper reports the findings around diagnosis and staging of HIV infection in children. Local setting At the time of the study, 58 health facilities were providing ART to children. Only one institution had achieved universal HIV testing in the antenatal clinics. Six facilities systematically followed up HIV-exposed children. HIV antibody testing was not readily available to the children. Although four research centres were capable of carrying out diagnostic HIV polymerase chain reaction (PCR), the services were restricted to research purposes. Other constraints were inadequate physical infrastructure, inadequate systems for quality control in the laboratories and shortage of staff. Lessons learnt The policy framework to support identification of HIV-infected children had been established, albeit with narrow focus on sick children. The assessment identified the weaknesses in the structures for systematic diagnosis of HIV through laboratory or clinical-based algorithms. The researchers concluded that health staff training and implementation of a systematic standard approach to identification of HIV-infected children is urgently required. Problematique En 2003, Le Ministere de la sante kenyan s'etait donne pour objectif de faire beneficier d'ici fin 2005 d'un traitement antiretroviral (ART) 50 % des 250 000 personnes qui pourraient y pretendre d'apres les estimations. En juillet 2005, 45 000 adultes et plus de 2000 enfants etaient sous traitement. Une etude a ete menee pour determiner les obstacles s'opposant a l'identification des enfants infectes par le VIH. Demarche Les politiques gouvernementales existantes ont ete examinees et le registre de delivrance du traitement ART du programme kenyan anti-VIH/sida a ete utilise pour identifier les etablissements distribuant ce traitement. Le present article rapporte les resultats en rapport avec le diagnostic et le stadage de l'infection a VIH chez l'enfant. Contexte local Lors de la realisation de l'etude, 58 etablissements de sante dispensaient le traitement ART a des enfants. Un seul de ces etablissements appliquait un depistage systematique du VIH dans son service antenatal. Six etablissements pratiquaient un suivi systematique des enfants exposes au VIH. On ne disposait pas facilement d'un test de recherche des anticorps applicabie aux enfants. Si quatre centres de recherche etaient en mesure de diagnostiquer le VIH/sida par une technique de type PCR, lis n'exercaient ces capacites qu'a des fins de recherche. L'etude a revele d'autres contraintes : infrastructure materielie inadequate, insuffisance des systemes de controle de la qualite des laboratoires et penurie de personnel. Enseignements tires Un cadre politique pour l'identification des enfants infectes par le VIH a ete etabli, meme s'il est trop etroitement axe sur les enfants malades. L'evaluation a mis en evidence les faiblesses des structures de diagnostic systematique du VIH par des examens en laboratoire ou par des algorithmes partant de donnees cliniques. Les chercheurs ont conclu qu'une formation du personnel de sante et que l'application de la demarche standard d'identification systematique des enfants infectes par le VIH s'imposaient d'urgence. Problema En 2003 la meta del Ministerio de Salud de Kenya para fines de 2005 era proporcionar tratamiento antirretroviral (TAR) a un 50% de las 250 000 personas que se estimaba que debian recibirlo. En julio de 2005, 45 000 adultos y mas de 2000 ninos estaban recibiendo tratamiento. Se realizo un estudio para determinar los obstaculos que dificultaban la identificacion de los ninos infectados por el VIH. Enfoque Se revisaron las politicas nacionales en vigor y se utilizo el registro de TAR del Programa Nacional de Lucha contra el SIDA de Kenya para localizar los centros que ofrecian ese tratamiento. En este articulo se informa sobre los resultados relativos al diagnostico y la estadificacion de la infeccion por VIH en los ninos. Contexto local En el momento de realizar el estudio, 58 establecimientos de salud proporcionaban TARa pacientes infantiles. Solo una institucion habia logrado implantar de forma universal las pruebas de deteccion del VIH en los dispensarios prenatales. Seis establecimientos sometieron a seguimiento sistematico a los ninos expuestos al VIH, pero estos no tenian facil acceso a la prueba de deteccion de anticuerpos contra el VIH. Aunque habia cuatro centros de investigacion que podian llevar a cabo la prueba diagnostica del VIH basada en la reaccion en cadena de la polimerasa (PRC), esos servicios se limitaban a los trabajos de investigacion. Otras restricciones eran una infraestructura fisica inadecuada, unos sistemas insuficientes de control de la calidad en los laboratorios y la escasez de personal. Ensenanzas extraidas Se habia establecido el marco normativo de apoyo a la identificacion de los ninos infectados por el VIH, si bien focalizando estrechamente esa actividad en los ninos enfermos. La evaluacion permitio identificar las deficiencias de que adolecian las estructuras de diagnostico sistematico de la infeccion por VIH mediante algoritmos clinicos o de laboratorio. Los investigadores llegaron a la conclusion de que urge emprender actividades de capacitacion del personal sanitario y aplicar un procedimiento normalizado sistematico de identificacion de los ninos infectados por el VIH. [TEXT NOT REPRODUCIBLE IN ASCII], Background Kenya's population of 30 million people has nearly 1.2 million people living with HIV/AIDS with at least 250 000 in need of immediate antiretroviral therapy (ART). In 2003, the [...]

A study examines early clinical and immunologic outcomes of children enrolled in the pediatric treatment program. The results conclude that good care provided by care providers improves the outcome of HIV-infected children in primary health care settings in Zambia.

Antiretroviral medications are becoming available for HIV-infected children in resource-limited settings. Maryknoll, an international Catholic charity, provided directly observed antiretroviral therapy to HIV-infected children in Phnom Penh, Cambodia. Child care workers administered generic antiretroviral drugs twice daily to children, ensuring adherence. Treatment began with 117 late-stage HIV-infected children; 22 died of AIDS during the first 6 months. The rest were treated for at least 6 months and showed CD4 count increases comparable to those achieved in US and European children. Staffing cost for this program was approximately US $5 per child per month, or 15% more than the price of the medications. Drug toxicities were uncommon and easily managed. Directly observed antiretroviral therapy appears to be a promising, low-cost strategy for ensuring adherent treatment for HIV-infected children in a resource-limited setting. doi:10.2105/AJPH.2005.083253

The demographic characteristics and the associated diagnostic and antiretroviral treatment (ART) efforts between the predominantly former plasma donation (FPD) and intravenous drug use (IDU) provinces are evaluated. The findings states that the national pediatric survey in China has pointed that the age and time needed for diagnosis are greater in HIV-infected children from FPD provinces compared with those from IDU provinces.

The HIV-1 p24 assay to dried blood spot (DBS) plasma antigen test was adapted to considerably reduce the known high background in DBS samples by introducing a peroxidase quenching step. It was found that DBS-p24 and plasma-p24 concentrations correlated well, independent of the ethnic background of the subjects or the HIV-1 subtype.

A study was conducted to determine the probable route of transmission of HIV to children aged 12 years or younger in a rural area of Uganda from 1999 through 2000 and to examine associations between HIV infection and health care-related variables. The findings suggest that a large number of injections were a consequence of AIDS-related illness rather then the cause of infection in vertically infected children.

The impact of malaria parasitemia on the absolute number of peripheral CD4 cells in both HIV-1-positive and HIV-negative adults who were treated for uncomplicated confirmed malaria is discussed. Interpretation of absolute CD4 count might be biased during or just after a clinical malaria episode.

A study was conducted to identify treatable and preventable infectious causes of morbidity and mortality in children affected by HIV during their first fifteen months of life and the role of bacterial sepsis in the natural history of AIDS in Haitian children. It was found that bacteremia, Staphylococcus aureus was partially responsible for excess illness and mortality in children born to HIV-infected mothers.

The association between [CD4.sup.4] depletion and immune activation in HIV-1 infected children on highly active antiretroviral therapy (HAART) is analyzed. Results reveal that elevated immune activation is responsible for [CD4.sup.} depletion rather than HIV replication because immunologic status is associated directly to immune activation and not to viral load levels in HIV-infected children on HAART.

Changes in the healthcare use among perinatally HIV-infected children are examined and new estimates of expected lifetime treatment costs are developed. Results revealed that hospitalizations among perinatally HIV-infected children decreased significantly from 1995 to 2001.

The successes of the United States and other developed countries in the prevention and treatment of pediatric HIV/AIDS have not been replicated in the developing world, where children continue to become infected with HIV and die from HIV/ AIDS at astounding rates. Children are underrepresented among recipients of antiretroviral therapy in almost every setting worldwide where treatment programs have been established. The barriers to scaling up HIV/AIDS care and treatment globally are substantial. Nevertheless, nearly a decade after the introduction of pediatric highly active antiretroviral therapy in the United States, the opportunity finally exists to provide treatment to huge numbers of HIV-infected children in the developing world, changing forever the way that pediatric HIV/ AIDS is perceived and managed. We propose the creation of a Clinical Centers of Excellence Network and Pediatric AIDS Corps of US pediatric health professionals, increased support for pediatric research relevant to resource-poor settings, commitment of the US government and others to proportionate funding for pediatric HIV/AIDS care and treatment, expanded availability of pediatric antiretroviral drug formulations, and a renewed commitment to collaborative partnerships as practical steps that can be taken to dramatically expand access of HIV-infected children and families in the developing world to health-restoring, life-prolonging care and treatment. Key Words HIV, international child health Abbreviations HAART--highly active antiretroviral therapy WHO--World Health Organization BIPAI--Baylor College of Medicine International Pediatric AIDS Initiative, THE NEAR ELIMINATION of new cases of HIV infection and AIDS among US children is 1 of a precious few public health success stories in the nearly 25-year history of […]

A cohort of 26 perinatally HIV-infected children who discontinued the protease inhibitors (PI) component of their highly active antiretroviral therapy (HAART) because of difficulties with adherence, toxicity, or virologic breakthrough is presented. Therapy simplification by partial treatment interruption may provide a practical option in patients intolerant of or failing PI-based highly active antiretroviral therapy.

The purpose of the current study was to evaluate a clinical program that used multisystemic therapy (MST) to improve regimen adherence and health outcomes among children with perinatally acquired HIV who exhibited high viral loads in the absence of viral resistance. MST is an intensive, home-based family therapy previously used for the treatment of serious antisocial behavior. Goals of the study were to assess the feasibility of the MST program and its effectiveness for improving health outcomes among children who were treated. The study was conducted by retrospective chart review. Ninety percent of children and families referred to the program accepted the referral and 95% received a full dose of treatment, suggesting high program feasibility. Nineteen children participated in the program. General HIV knowledge on the part of caregivers improved significantly over the course of treatment. Although caregiver-reported adherence did not change, viral loads were found to significantly decrease from referral to the end of MST treatment, with the mean change reflecting a greater than 1 [log.sub.10] decrease. The majority of children maintained these improvements during the 3 months after treatment termination. Results suggest that MST holds promise as an intervention for improving health outcomes among pediatric patients with HIV.

A program to provide maternal and newborn doses of nevirapine to pregnant women in rural Uganda is conducted to assess the effectiveness of maternal self-administration of nevirapine for prevention of mother-to-child transmission (MTCT) of HIV. Women provided blood for HIV testing and were offered voluntary counseling and testing (VCT) during annual community HIV surveys.

The study was aimed to analyze and determine genotypic and pharmacologic predictive factors of virologic success. A prospective genotypic resistance analysis was also performed in patients who experienced virologic failure.

Byline: Shimareet Kumar (1), Mariarita Santi (1), Gilbert Vezina (2), Tena Rosser (3), Roma S. Chandra (1), Robert Keating (4) Keywords: Epstein-Barr virus; human immunodeficiency virus; brain; leiomyoma Abstract: We describe the clinicopathologic features of an Epstein-Barr virus (EBV)-associated smooth muscle tumor arising in the basal ganglia of a 10-year-old human immunodeficiency virus (HIV)-positive child. Only a few cases of intracranial smooth muscle tumors are reported in the literature and virtually all of these have been extra-axial, involving the dura or sinuses in HIV+ adults. Our case underscores the need to include an EBV-associated smooth muscle tumor in the differential diagnosis when evaluating intracranial mass lesions in immunodeficient children. Author Affiliation: (1) Department of Anatomic Pathology, Suite 1620, Children's National Medical Center, 111 Michigan Avenue N.W., Washington, DC, 20010, USA (2) Department of Radiology, Children's National Medical Center, Washington, DC, USA (3) Department of Neurology, Children's National Medical Center, Washington, DC, USA (4) Department of Neurosurgery, Children's National Medical Center, Washington, DC, USA Article History: Registration Date: 01/01/2003 Received Date: 29/07/2003 Accepted Date: 13/11/2003 Online Date: 17/03/2004 Article note: Corresponding author, e-mail:

A number of debates exist in Africa, due to the HIV epidemics, on whether institutionalized compared with community-based care provide optimum management of infected children. Patterns of morbidity and mortality among HIV-1-infected children residing at an orphanage in Nairobi are characterized.