SURVIVAL IN THE MODERN ART ERA: Edited by Margaret May and Dominique CostagliolaSurvival of HIV-1 vertically infected childrenDavies, Mary-Ann; Gibb, Diana; Turkova, AnnaAuthor Information aCentre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa bMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London cImperial College Healthcare Trust, St Mary's Hospital, London, UK Correspondence to Mary-Ann Davies, Centre for Infectious Disease Epidemiology and Research, Falmouth Building Level 5 University of Cape Town Faculty of Health Sciences, Anzio Rd, Observatory, Cape Town 7925, South Africa. Tel: +27 21 4066808; e-mail: [email protected] Current Opinion in HIV and AIDS: September 2016 - Volume 11 - Issue 5 - p 455-464 doi: 10.1097/COH.0000000000000303 Buy Metrics Abstract Purpose of review It is 20 years since the start of the combination antiretroviral therapy (cART) era and more than 10 years since cART scale-up began in resource-limited settings. We examined survival of vertically HIV-infected infants and children in the cART era. Recent findings Good survival has been achieved on cART in all settings with up to 10-fold mortality reductions compared with before cART availability. Although mortality risk remains high in the first few months after cART initiation in young children with severe disease, it drops rapidly thereafter even for those who started with advanced disease, and longer term mortality risk is low. However, suboptimal retention on cART in routine programs threatens good survival outcomes and even on treatment children continue to experience high comorbidity risk; infections remain the major cause of death. Interventions to address infection risk include a cotrimoxazole prophylaxis, isoniazid preventive therapy, routine childhood and influenza immunization, and improving maternal survival. Summary Pediatric survival has improved substantially with cART and HIV-infected children are aging into adulthood. It is important to ensure access to diagnosis and early cART, good program retention as well as optimal comorbidity prophylaxis and treatment to achieve the best possible long-term survival and health outcomes for vertically infected children. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.