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Handbook of Pediatric HIV Care, 2nd Edition

Ammann, Arthur J MD

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1st, 2006 - Volume 43 - Issue 4 - p 495-496
doi: 10.1097/01.qai.0000243124.98024.93
Book Review

Center for HIV Information, President, Global Strategies for HIV Prevention, University of California Medical Center, San Francisco, CA

Handbook of Pediatric HIV Care, 2nd Edition.

Edited by Steven L. Zeichner and Jennifer S. Read. Cambridge University Press, New York, NY, 2006. ISBN-10: 0521529069, Pages: 871.

Undertaking a revision of a handbook on pediatric HIV care is not an easy task. Advances in HIV prevention and treatment have occurred rapidly, and nowhere in the HIV epidemic have prevention efforts been more successful than with the prevention of mother-to-child transmission. The second edition of the Handbook of Pediatric HIV Care, edited by Steven L. Zeichner and Jennifer S. Read, both from the National Institutes of Health, has accomplished the outstanding task of updating recent advances in management of pediatric HIV infection and integrating new information with previous essential knowledge. The handbook consists of 6 major sections and 39 individual chapters on topics that range from the basics of HIV infection to treatment of complications of HIV. Also included are chapters on legal and psychosocial issues. All contributors to this volume have extensive expertise in pediatric HIV care.

Chapter 11 on antiretroviral drugs (ARVs) by McKinney includes the most recent antiretroviral drugs, as well as some not yet officially approved by the FDA for pediatric use. Each ARV is discussed in an overview that covers antiretroviral effects, pharmacokinetics, and adverse effects, all concisely presented for rapid understanding; this chapter will provide a quick reference to practitioners treating HIV-infected children. Drug dosing tables are in the appendix, located conveniently with other drugs commonly used for HIV-infected children.

Drug interactions have become more important as the list of new ARVs continues to increase and as combination drug therapy has become the standard. An entirely separate chapter presents the most recent information on the metabolic effects of ARVs-complications that are increasingly observed as children are treated with combination drugs and live longer. Similarly, issues related to growth and development, including neurologic development, have assumed greater importance as long-term survival of pediatric patients increases. Chapter 9, by Chantry and Moye, on growth, metabolism, and nutrition is thorough and includes a discussion of issues relevant to resource-poor countries. Neurologic development is covered in detail in Chapter 19, by Civitello. Other issues that are of critical importance as HIV-infected children grow older are related to daycare, school attendance (Chapter 36, by Chanock), and psychosocial factors encountered as children deal with their own mortality and that of others (Chapter 38, by Wiener).

Prevention of HIV transmission from mothers to infants (PMTCT) and prevention of infection after occupational or sexual exposures are extensively addressed in two separate chapters (Chapters 4 [Read] and 17 [Havens and Dominguez], respectively). The chapter on PMTCT provides an overview of treatment and prevention regimens as well as updates and perspectives on prevention approaches. Exclusive breast-feeding as a means of reducing HIV transmission, an issue of importance in resource-poor settings, is not discussed.

Chapter 15, “Initiating and Changing Antiretroviral Therapy,” by Mofenson and Serchuck, is especially well presented and updated. An overabundance of guidelines on treatment from international organizations, such as the World Health Organization (WHO), the U.S. Centers for Disease Control Prevention (CDC), the U.S. Public Health Service, and the European Union, often creates difficulties for those caring for HIV-infected infants when they attempt to determine the best approaches to monitoring and treatment. This chapter provides an accurate assessment of the various guidelines, and it presents, in a much more simplified manner, approaches that should be used when initiating or changing antiretroviral therapy. Each issue is presented concisely: when to change therapy, choosing ARV regimens, immunologic and virologic failure, and disease progression. Important footnotes are added to a table on drugs that address toxicity issues and limitations in drug dosing.

Opportunistic infections are the primary complications of HIV infection. The book covers treatment of other infectious diseases, including tuberculosis, Pneumocystis, fungal infections, and viral infections. Treatment tables for drug dosing are included in the appendix. A weakness of the handbook is that it does not cover some infections that are of importance to practitioners caring for HIV-infected patients in resource-poor regions. For example, there is no discussion of the role of malaria in transmission of HIV or of the high mortality in co-infected pregnant women and infants. A discussion of low-cost laboratory tests, such as total lymphocyte counts as a substitute for CD4 counts and same-day rapid HIV tests, also would have been useful.

Black and white photographs are used liberally throughout the handbook and are useful for radiographic illustrations but are lacking for certain clinical features. The numerous tables used throughout the handbook are helpful for overviews. Many tables also contain highly useful information on drug treatment; for example, the ARV table contains not only drug dosing information but also whether the drug has been approved by the FDA and whether the drug is provided in a pediatric formulation. Drug stability is also included, and this information is of great importance to individuals practicing in resource-poor countries. The table on drug dosing for opportunistic infection is similarly constructed and should be of great value for managing secondary infections in HIV-infected children. As in the text, however, information on drugs to treat malaria is lacking.

The handbook offers additional useful resources in the appendix, which includes lists and contact information on organizations in the United States that provide legal assistance, NIH-sponsored clinical research sites, and Web site URLs that deal with HIV. Unfortunately, the latter includes some sites that are not maintained or that are not specific for children with HIV infection and omits one of the most extensive and up-to-date sites, especially for resource-poor countries,, available since 2003.

The handbook is considerably larger than the previous edition and now consists of 871 pages, much larger than a handbook that could easily be carried on the person. Nevertheless, the inclusion of extensive updates, the format, and attention to issues that are of major importance all contribute to its usefulness. As the number of pediatric HIV-infected patients continues to decrease in developed countries but to increase dramatically in resource-poor countries, it can be anticipated that future editions of this Handbook of Pediatric HIV Care will incorporate issues of greater relevance in resource-poor settings.

The handbook is meant for a broad range of health care workers who deal with the complex issues that involve care and treatment of HIV-infected children. The book spans care of children from infancy to adolescence. It significantly updates the hardcover version published as a textbook in 2005. A price of less than $100 for the handbook is considerably more affordable and attractive than more expensive textbooks.

Overall, the handbook is an important and useful update that can be recommended to those engaged in HIV prevention and care in children and to those who want an affordable and easily understood resource for providing up-to-date care and treatment information for children infected with HIV.

Arthur J. Ammann, MD

Center for HIV Information President, Global Strategies for HIV Prevention University of California Medical Center San Francisco, CA

© 2006 Lippincott Williams & Wilkins, Inc.