Growing Up with HIV: Children, Adolescents, and Young Adults with Perinatally Acquired HIV Infection∗

Tremendous success in the prevention and treatment of pediatric HIVin high-resource countries has changed the face of the epidemic. Aperinatally HIV-infected child now faces a chronic disease rather than aprogressive, fatal one. However, these successes pose new challenges asperinatally HIV-infected youth survive into adulthood. These includemaintaining adherence to long-term, likely life-long therapy; selectingsuccessive antiretroviral drug regimens, given the limited availability ofpediatric formulations and the lack of pharmacokinetic and safety datain children; and overcoming extensive drug resistance in multi-drugexperiencedchildren. Pediatric HIV care now focuses on morbidityrelated to long-term HIV infection and its treatment. Survival intoadulthood of perinatally HIV-infected youth in high-resource countriesencourages expansion of pediatric treatment programs in low-resourcecountries, where most HIV-infected children live, and provides importantlessons about how the epidemic changes with increasing access toantiretroviral therapy for children.