Treat All: Transforming Pediatric HIV Care, Yet Challenges Remain

The year 2015 marked a significant milestone in the global fight against HIV/AIDS, as CD4-based clinical staging criteria for antiretroviral therapy (ART) initiation were eliminated, ushering in the era of "Treat All." This revolutionary change extended ART eligibility, ensuring that children, who have long borne a disproportionate burden of HIV-related deaths, could access life-saving treatment. A recent study investigating the impact of "Treat All" on pediatric HIV outcomes sheds light on the efforts made but also highlights the need for continued steps to address lingering challenges.

The study comprehensively analyzed data spanning 11 years, abstracting ART coverage and AIDS mortality statistics across many countries. The findings reveal an encouraging narrative of progress. Pediatric ART coverage tripled from a meager 16% in 2010 to a more promising 54% in 2020, while AIDS-related deaths were halved from 240,000 to 99,000 over the same period. These statistics testify to the effectiveness of the "Treat All" approach in improving access to treatment and saving countless young lives.

However, the study also found that the rate of increase in ART coverage slowed by 6% after adopting "Treat All," while the rate of decline in AIDS mortality decreased by 8% during the post-implementation period. These observations underscore the need to reevaluate and recalibrate strategies to ensure that the momentum gained from "Treat All" is not lost.

In conclusion, the study highlights the impact of "Treat All" on pediatric HIV outcomes. However, it also serves as a reminder that the journey is far from over. The global community must remain committed to not only sustaining but accelerating the progress made to ensure that every child living with HIV has the opportunity to lead a healthy and fulfilling life.

Rosen JG et al. Pediatric Antiretroviral Therapy Coverage and AIDS Deaths in the "Treat All" Era. Pediatrics.2023;151 (6): e2022059013. https://doi.org/10.1542/peds.2022-059013