Treatment of MDR/XDR TB in Children - Ben Marais, MD

Presenter: Ben Marais, MD | University of Sydney, Australia
Lecture: Treatment of MDR/XDR TB in Children
Session 3: Comorbidities/Co-infections
Presented in the International Workshop on HIV & Pediatrics 2023
International Workshop on HIV & Pediatrics 2023
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Meeting Description
Although we have witnessed a dramatic global scale-up of antiretroviral treatment (ART) as well as efforts to prevent vertical HIV transmission in the last decade, there were 150,000 new pediatric infections in 2021 and an estimated 1.68 million children under 15 years of age living with HIV. Children are substantially less likely than adults to be diagnosed, initiate treatment, and achieve durable viral suppression. Currently, only 54% are receiving ART, and treatment of pediatric HIV, particularly in infants and young children, remains complex and problematic, with continued use of suboptimal ART formulations and regimens.
Furthermore, adolescents are one of the most rapidly growing populations with HIV; in 2021, there were an estimated 410,000 new HIV infections among young people aged 15- 24 years, accounting for 27% of all new HIV infections globally. HIV infections among adolescent girls and young women are 65% higher than among adolescent boys and young men of the same age, with 4,900 new infections occurring in young women weekly. HIV remains one of the leading causes of death among adolescents living in Africa and among the top 10 causes of death in adolescents globally. The uptake of HIV testing among adolescents has remained low. Programs continue to struggle to reach and retain adolescents in care, and adherence to treatment has special challenges, particularly among those with perinatal infection aging up into adolescence and young adulthood.
As research to improve pediatric HIV diagnosis and care is ongoing, new scientific questions of critical importance have also emerged. In settings with mature ART programs, an increasing proportion of new pediatric infections is attributed to women acquiring HIV infection during pregnancy and breastfeeding, periods of markedly increased risk of HIV acquisition for the mother. With the scale-up of ART for PMTCT, the prevalence of pre-treatment antiretroviral (ARV) drug resistance, particularly to non-nucleoside reverse transcriptase inhibitor drugs, has escalated among newly diagnosed infants, jeopardizing ART effectiveness. Additionally, with more than 1.3 million pregnant women globally receiving ART, there are increasing concerns about the long-term impact of in utero and postnatal exposures to medications for those children who escape HIV.
Currently, the global population of HIV-exposed uninfected children and adolescents is estimated at 14.8 million, including over 8 million with in-utero ARV exposure. An initial early report of an association with periconception dolutegravir exposure and increased risk of neural tube defects, which upon an increase in the number of periconception exposures subsequently is no longer found, has underscored the need for ongoing attention to surveillance of safety of ARVs in pregnancy. Innovation in early infant diagnosis such as point-of-care tests has facilitated earlier identification of HIV infection during infancy, providing exciting new opportunities to study acute infection and very early treatment in neonates and promising remission strategies. However, despite the critical importance of these topics, research in pediatric, adolescent, and maternal HIV infection is often neglected at major scientific HIV conferences.
Therefore, in collaboration with leading experts in the field, we have established a highly focused international workshop on the prevention and treatment of pediatric HIV. The overall objective of the International Workshop on HIV & Pediatrics is to stimulate research that will advance prevention and treatment strategies for infants, children, and adolescents.