Paediatric HIV
Symptoms, transmission, and current treatments for paediatric HIV
Paediatric HIV
Symptoms, transmission, and current treatments for paediatric HIV
What is HIV?
The human immunodeficiency virus (HIV) is a virus that weakens the immune system, making the body less able to fight infections and cancers. Without treatment, HIV continues replicating within the body leading to an advanced stage of HIV infection called Acquired Immunodeficiency Syndrome (AIDS). At this stage, the body is very vulnerable to infections and cancers that can typically be fought by a healthy immune system, leading to chronic illness and death.
Infants and young children with HIV are particularly vulnerable, with most not surviving to the age of five without treatment. Transmission of the HIV virus from a pregnant mother to a child can be easily prevented with current treatments, but a high number of paediatric infections still occur in some developing countries despite global progress in preventing mother-to-child transmission.
What is the impact of paediatric HIV?
- 1.4 million children living with HIV
- 120,000 new HIV cases in children in 2024
- 84% of children living with HIV in 2024 live in sub-Saharan Africa
- Only 55% of children with HIV receive treatment – compared to 78% of adults with HIV
- Without treatment, half of children with HIV will die before turning two
- Children comprised 3.5% of people living with HIV in 2024 but 12% of AIDS-related deaths
How is HIV in children treated?
At present, HIV cannot be cured, but it can be managed with combinations of antiretroviral drugs. However, due to the relatively low number of children living with HIV compared to adults, research on new HIV medicines specifically for children has been neglected.
The World Health Organization (WHO) recommends first-line treatment for infants and children consisting of dolutegravir (DTG) with two nucleoside reverse transcriptase inhibitors. It recommends lopinavir/ritonavir (LPV/r) with two nucleoside reverse transcriptase inhibitors where DTG cannot be used. Until recently, the only protease inhibitor available for young children was LPV/r, available in a form that was:
- not child-friendly (the syrup tastes terrible and contains 42% alcohol)
- not suitable for poor communities because it needs to be stored in a fridge
- difficult to store and transport.
Together with our partner Cipla, we have developed sweet-tasting, heat-stable, ‘4-in-1’ granules to treat young children, which were first approved by the South African Health Products Regulatory Authority (SAHPRA) in 2022 and later by other countries. Carers can give the medicine to children by sprinkling the granules over soft food like porridge or dissolving it in water or milk.
Multiple new child-friendly formulations of WHO-recommended regimens have now been introduced, representing a long-awaited and long overdue treatment revolution for children with HIV.
UNAIDS targets state that 95% of children with known HIV status should be on treatment by 2025. More child-friendly medicines are needed to roll-out treatment to more babies and young children, who are either receiving no treatment or suboptimal treatments. Access is also a problem: only 55% of children with HIV received antiretroviral treatment in 2024.
How do children get HIV?
- 90% of children with HIV acquired the virus from their mothers during pregnancy, delivery, or through breast-feeding.
- Effective treatment can prevent HIV transmission from a mother to her child, but not all pregnant women with HIV have access to these treatments.
What is the effect of HIV on children?
Babies with HIV develop the same symptoms as adults, but the disease progresses faster. Symptoms include:
- slow growth and weight gain
- severe wasting
- diarrhoea and upper respiratory tract infections that cause increased medical problems and death
- infections such as tuberculosis
How is HIV in children diagnosed?
Rapid HIV-antibody tests have made field diagnosis of HIV inexpensive and technically feasible in poor communities.
Last updated: September 2025
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