Infección por virus de inmunodeficiencia humana en niños: nueve años de seguimiento / Human immunodeficiency virus infection in children: 9 years follow up

ABSTRACT

The first chilean pediatric AIDS patients, horizontally and vertically infected, were detected in 1987 and 1989 respectively. In 1990, the National Pediatric AIDS Committee of the Chilean Pediatric Society was founded. To october 1997, 68 newborn of 259 HIV pregnant women (26,7 percent) acquired the infection with a global lethality of 36,5 percent. In those treated (antiretroviral therapy, monthly intravenous immunoglobulin and cotrimoxazol) the observed lethality was 25,8 percent. Mean survival was 47 month (3-184). From 1995 the ACTG-076 protocol was introduced (sometimes partially implemented) reducing vertical transmission from 27,0 to 13,2 percent. Nowadays vertically transmitted infection is confirmed or ruled out before 3 months of age employing ELISA and IFA for antibodies detection, P24 antigen search and PCR. Committee Recommendations for AIDS treatment Antiretroviral therapy must be administered to all newborn of pregnant women in the ACTG-076 protocol and to all siblings with confirmed infection independently of their clinical/immunological cathegory or viral load. Resource restrictions may oblite specialists to prefer symptomatic patients or those with CD4 counts deterioration for antiviral treatment. A modern anti VIH treatment must include 2 reverse transcriptase inhibitors (nucleoside or no nucleoside analogues) plus one protease inhibitor depending on clinical individual situation and drugs disponibility. Besides, intravenous immunoglobulin must be prescribed monthly to all symptomatic patients