Track B report by Jason Brophy
This session focused on issues related to children growing up with HIV, from both the patient and provider perspective.
The session began with testimonials from two Thai youth living with HIV. Each of them spoke eloquently of their life experiences growing up with HIV, including struggles with a number of issues commonly cited as concerns – losing parents to HIV, denial of education, treatment side effects, and disclosure in intimate relationships. Their message to attendees was of their desire for a normal life and opportunities to achieve their goals, and their request of support for HIV-affected children like them to live well. The audience was very moved by their stories and bravery.
Dr. Tudor-Williams spoke about ART management of children living with HIV, with a focus on older youth. He discussed the dilemma of guidelines like those introduced at this conference, which need to serve both public health and individual interests. Simplicity, standardization, and harmonization with adult approaches are helpful for implementation and in saving the maximum number of lives, but the individual needs of patients are also important. Evidence regarding treatment strategies, such as use of abacavir/lamivudine backbones and 4-drug versus 3-drug induction strategies in children, was reviewed as well as approaches to the important issue of adherence.
Dr. Puthanakit presented evidence on long-term complications of HIV and ART. She focused on 3 main areas – brain, bone, and cardiovascular complications. Earlier therapy is one approach to avoid poor neurodevelopmental outcomes, which may impact ability for self-care in the future for these youth. Poor bone health and cardiovascular outcomes are a significant concern for perinatally infected children, and more research is needed to determine preventive and treatment approaches in this population.
Dr. Persaud spoke about recent progress in the search for a cure for HIV, and in particular the pediatric perspective of these developments. HIV cure has been an elusive goal due to the establishment of a persistent HIV reservoir, and children diagnosed at an older age appear to establish reservoirs in a similar manner to adults. Insights from the “Berlin patient” and the “Mississippi case” have changed the framework of what is conceived as possible with relation to sterilizing (clearance of infection) and functional (persistent infection controlled by host-related mechanisms) HIV cure. In pediatrics, it appears that very early therapy may afford the opportunity to prevent long-lived reservoir establishment, similar to evidence from adult studies like SEARCH 010 and the Visconti cohort. An exciting cure research agenda is underway including plans for early treatment protocols for HIV-infected infants.