Pediatric adherence to antiretroviral therapy in resource-poor settings: challenges and future perspectives

The HIV pediatric epidemic in low-income countries is still growing with an increasing impact on children. By the end of 2007, more than 2 million children under 15 years of age worldwide were living with HIV, 90% in subSaharan Africa. In that year alone, 370,000 children were newly infected and 270,000 died. AIDS has become one of the leading causes of mortality among children under the age of 5 years in developing countries [101]. In the absence of combination antiretroviral therapy (cART), 52% of children infected with perinatally acquired HIV infection will die by the age of 2 years [1]. Numerous studies have confirmed the clinical efficacy and feasibility of cART in HIVinfected adults in Africa [2,3] but, to date, resources and programs targeting HIV-infected children in resource-poor settings remain limited. Even though the use of cART to treat children has increased in recent years in subSaharan Africa, less than 15% of children needing cART in Africa currently receive it [102]. It is estimated that more than 780,000 children are in need of cART in lowand middle-income countries [103]. When made accessible, treatment for children in this context has proved highly effective [4]. Studies have found the survival probability at 12 months for children on cART to be more than 95% in settings in sub-Saharan Africa [5] and Asia [6]. Education and adherence counseling are therefore essential components of cART and adherence in HIV-infected children is critical to the success of cART.