By connecting expectant mothers living with HIV to appropriate care, communities around the world have greatly reduced the number of children who acquire the virus at childbirth or during breastfeeding. In 2017, the number of children under the age of 13 living with HIV in the United States was less than 30 according to the Centers for Disease Control and Prevention. Additionally, many countries have virtually eliminated mother to child, or perinatal, transmission of HIV. Read more about prevention of perinatal transmission of HIV.
Still, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 1.8 million children under 15 years old worldwide were living with HIV in 2017. Because children can differ greatly from adults in size, metabolism, and organ function, most medical interventions, including HIV treatment, must be tailored for pediatric patients in order to remain safe and effective. NIAID plays a critical role in supporting research that refines medical understanding of the HIV drugs and doses most appropriate for children living with HIV.
The first clinical trials to evaluate anti-HIV drugs enrolled adult participants, but clinical trials to determine the safety and efficacy of some of these drugs in children and pregnant women with HIV soon followed. Studies undertaken by the NIAID-supported Pediatric AIDS Clinical Trials Group (PACTG) found that, much like in adults, effective treatment for children living with HIV required a potent combination of antiretroviral drugs. These studies also helped standardize the dose and formulation of certain HIV drugs that worked best in every stage of childhood from infancy through adolescence. In 2006, the PACTG merged with the Perinatal Scientific Working Group of the HIV Prevention Trials Network (HPTN) to form the International Maternal Pediatric Adolescent AIDS Clinical Trials Network, or IMPAACT. Through similar research by specialized investigators, NIAID continues to ensure pediatric label information on the appropriate dosing and formulation for children is available for HIV drugs. This research is frequently supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
NIAID also supports research that seeks to establish how to best use HIV treatments to ensure the long-term health of young people living with HIV. For example, in 2005, NIAID launched the Children with HIV Early Antiretroviral Therapy (CHER) trial in South Africa to evaluate different approaches to HIV treatment in children under 3 months. The study sought to answer whether children fared best beginning antiretroviral therapy immediately after childbirth and diagnosis or beginning only after their immune systems began to decline. In 2007, the former approach was found to greatly reduce the chance of infant mortality, and investigators continued with their work by giving all children under 3 months antiretroviral drugs immediately after diagnosis. In 2012, early antiretroviral therapy was found not only to improve chances of survival but also to ensure normal immune system and neurological development.
One child enrolled in the CHER trial who received anti-HIV treatment during infancy suppressed the virus without anti-HIV drugs for eight and a half years, scientists reported in 2017. This unusual case suggests the possibility that some children may be able to sustain viral suppression without continuous daily antiretroviral therapy if they receive a course of antiretroviral therapy early in life. This hypothesis is currently being tested in the ongoing, NIAID- and NICHD-supported IMPAACT P1115 trial. IMPAACT P1115 will enroll nearly 500 infants and their mothers and evaluate whether giving anti-HIV therapy soon after birth to infants who became infected with HIV in the womb leads to remission of the virus, enabling the children eventually to stop treatment for an extended time period. Learn more about sustained antiretroviral-free HIV remission.