Surgical aspects of HIV infection in children

According to the joint United Nations Programme on HIV/AIDS (UNAIDS), 37.9 million adults and children worldwide were estimated to be living with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) at the end of 2018 (UNAIDS 2019). Most reside in low- and middle-income countries, with approximately 67.5% in sub-Saharan Africa (SSA). At the end of 2018, the total number of children under 15 years of age living with HIV infection was 1.7 million, of whom 1.55 million (91%) were living in SSA. The annual number of incident (new) HIV infections among children decreased to 160,000 in 2018. Thus, paediatric HIV infection is a pandemic affecting children, predominantly in SSA, but is also seen in Asia and sporadically elsewhere. Between 2000 and 2018, prevention of mother-to-child transmission (PMTCT) intervention programmes have averted an estimated 1.1 million deaths and two million new HIV infections among children globally (UNAIDS 2019). These programmes include early identification of HIV infection in pregnant or breastfeeding women through routine HIV testing, provision of lifelong antiretroviral therapy (ART) to all HIV-infected women who are pregnant or breastfeeding, provision of antiretroviral prophylaxis to their newborn infants during the first 6-12 weeks of life, delivery by elective caesarean section when indicated, promotion of exclusive breastfeeding for the first six months of life and thereafter, the introduction of complementary foods while continuing breastfeeding for up to 24 months of life or longer, early infancy screening for HIV infection, and initiation of ART in infants with HIV infection (World Health Organization 2011, World Health Organization 2013, UNAIDS 2015). HIV-infected children may require surgery, either as an emergency to deal with a life-threatening condition, or a complication of the disease. Non-emergency surgical procedures may be required to assist in the diagnosis of an HIV-related condition or to correct a routine surgical problem electively. Surgical conditions associated with HIV infection are described under the categories of soft tissue or organ-specific infections requiring drainage or debridement; gastrointestinal tract disease and complications; infections in the perineal area; and malignancies. Although surgical outcomes are less favourable in HIV-infected children, pre-operative treatment of co-infections, administration of co-trimoxazole prophylaxis, nutritional support, and ART, together with peri-operative antibiotic prophylaxis have resulted in excellent short-term outcomes (Eley et al., BMC Infect Dis 2:3, 2002; Karpelowsky et al., Pediatr Surg Int 28:1007-1014, 2012).