When Cambridge University Press decided to undertake the publication of the second edition of the Handbook of Pediatric Care, they told us that they were very enthusiastic about the book, but that they thought that, while the handbook was too large to be a true “handbook,” they still valued and appreciated the more comprehensive content of the book. The Press therefore asked us, for the second edition, to both shorten the material to a more manageable size to make a new handbook and to augment the material in the handbook to make an even more comprehensive Textbook of Pediatric HIV Care. We hope that we have achieved these goals in these two books, a second edition of the Handbook of Pediatric HIV Care and the first edition of the Textbook of Pediatric HIV Care.

Our goals for both books are to provide the clinician with the information needed to provide excellent care to children infected with HIV. Neither book is meant to be an exhaustive treatise on the subject of pediatric HIV disease, covering all the many societal and policy issues that are involved necessarily in a complete discussion of HIV and children. Rather, we aim to provide helpful management information for the frontline clinician. While we have focused on the management of pediatric HIV disease, we believe that effective management requires a solid understanding of the basic and applied virology, immunology, and pathophysiology of the disease, so that the practitioner can thoughtfully and rationally apply the management information supplied in the other chapters.

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.