Search

Introduction of Highly Active Antiretroviral Therapy (HAART) and implementation of preventive strategies during pregnancy have resulted in a dramatic reduction of the mortality rate in HIV-1 infected children by over 80-90% and in a decrease in the risk of mother-to-child transmission (MCTC) of HIV-1 to approximately 1-2%. However the MCTC remains the main source of HIV-1 infection within the paediatric population. The risk of disease progression is inversely correlated with the age of the child, with the youngest children at greatest risk of rapid disease progression, but in the first year of life it is not possible to identify infants at greatest risk; therefore, according to all the international guidelines, it is necessary to start antiretroviral therapy in all infants < 12 months of age. This article provides a summary of the clinical features of the infection and of the methods for diagnosis. Furthermore it offers an overview of antiretroviral therapy in HIV-1 infected children, including a description of the main classes of antiretroviral drugs, the most common side effects and some issues concerning the disclosure of diagnosis. The objectives of this study are to make a set of practical suggestions to paediatricians for the optimum management of the infection and the antiretroviral therapy.

The pharmacokinetics of valganciclovir were studied in 8 infants ranging in age from 4 to 90 days (mean 20 days). We suggest that doses of 15 mg/kg given twice daily may be suitable for neonates and young infants.

The aims of the study were to evaluate the economic burden of hospitalisations due to varicella in an Italian paediatric hospital during a 1-year period and to compare the data with potential expenses projected for a varicella mass vaccination programme.An observational, retrospective, cohort study was designed to measure hospital admission costs in a cohort of paediatric patients with varicella in a 12-month period. A cost comparison with a vaccination programme planned to prevent varicella in a whole birth cohort was performed. All children 0-16 years referred to the Anna Meyer Children's Hospital (AMCH) were considered. Since AMCH is a tertiary-level hospital and accept patients from other Italian regions, in order to avoid overestimation of hospitalisation expenses, all analyses pertaining to both vaccination and hospitalisation costs were uniquely calculated on the basis of the cohort of residents in the district of Florence.A total of 279 children were examined in the emergency department for varicella; 47/279 (16.8%) were sent to the inpatient clinic. The highest rate of hospitalisation (85.1%) was found in children4 years of age, and the largest number of complications (87.2%) occurred in previously healthy children. Mean length of hospitalisation (5.7 +/- 0.6 days) was similar to that reported in other western countries.Excluding any indirect cost, permanent sequelae and serious outcomes such as death, hospital expenses (corresponding to euro239 654 in a 1-year period), would account for around 80% of total expenses for vaccinating an entire birth cohort (euro310353).