Introduction

When we were in training to be pediatricians we diagnosed and treated some of the first children infected with HIV seen in our hospitals. We watched as most of them died quickly, within the first year or two of life, and we saw many of their parents die too. Over the following few years we witnessed the wards of our hospitals fill with children infected with HIV, at least in part because the growing epidemic was not viewed as a serious threat to the population as a whole, a threat that needed to be confronted with the determination and the resources appropriate to the magnitude of that threat.

As the epidemic expanded we initially had few effective therapies, either for HIV infection itself or for the opportunistic infections that complicate the disease. The numbing morbidity and mortality of HIV infection in children grew; we continued to see our patients and their parents die. Slowly, we saw more effective treatments for opportunistic infections and for HIV infection itself come into use. We saw the development of serological tests to diagnose HIV infection, of the first antiretroviral agents and agents for the prevention and treatment of opportunistic infections, of more effective antiretroviral agents, of methods to employ antiviral agents in effective combinations that can drive the viral load to low levels, of assays to determine viral load and methods to use the viral load assays to measure the effectiveness of antiretroviral therapy, of methods to assess whether a patient's virus is resistant to antiretroviral agents and approaches to select optimum combinations of antiretroviral agents, and of therapeutic approaches that dramatically decrease the likelihood that an infected mother will transmit HIV to her newborn.