Dr Ira Shah.
Medical Sciences Department, Pediatric Oncall, Mumbai, India. | As we celebrate World AIDS day on 1st December, it is moment to ponder and recapitulate all that has been done to make it a moment of "celebration".
- Is it the discovery of the vicious virus called "Human Immunodeficiency Virus" that leads to AIDS?
- Is it the various laboratory diagnostics especially the Nobel Award winner "Polymerase Chain Reaction (PCR)" that have really eased the diagnosis of this disease?
- Is it the discovery of the first drug zidovudine (AZT/ZDV) that is used for treatment of HIV which was incidentally developed as an anticancer drug?
- Is it the subsequent advances that lead to production of various antiretroviral drugs (ARVs) that have given over 20 ARV drugs to the physician for treatment of HIV?
- Is it that prevention of HIV in children is actually attainable and that countries have actually achieved the near impossible goal of decreasing mother to child transmission of HIV to less than 1%?
- Is it that from a 100% fatal disease, HIV is now a chronic manageable disease?
There are several wonderful milestones in this three decade old epidemic that have seen the decline of this disease in many countries. But is it still a day of celebration? There are still several stages one will have to wait for which in true words will be a cause of celebration and that would be
- A good HIV vaccine that helps to prevent transmission of HIV.
- Drugs that "cure" HIV and not "control" HIV, thus changing HIV from a chronic manageable disease to a disease that can be cured.
Hence, there is lot to be achieved, yet all that has been gained till date also needs to be implemented to ensure that HIV truly declines in the World.
AIDS Epidemic:
The AIDS epidemic was first noticed in the late 1980's, peaked in the 1990's and is now on the declining trend in the 2000's. However in countries in Africa and India, the epidemic is still at its peak and the decline seems to be several years away. Developed countries in Western Europe and America have strived amazingly hard and fired all guns to bring this epidemic under control. We, in India, still have to run against this race against time and work hard to change mindset, work attitude and give up the fatalistic approach. Incidences of pediatric HIV in developed countries is on the decline and less than 500 cases/year of new pediatric HIV infection are reported in these countries. However, in India, we still continue to see kids being newly diagnosed with HIV and till we don't stand up and do anything for it, we will continue to be slaves to this virus for years. As a pediatric HIV specialist, having seen hundreds of HIV infected children and having made some challenging diagnosis, treated and revived near death children and achieved laurels and merits along the way, it is still saddening to know that maybe the specialty of Pediatric HIV may still be needed 30 years down the lane. What can be prevented by a good parent to child transmission prevention programme is still to be implemented in our country and till then we will continue to see HIV infected children and be heartened and disheartened with their small victories and fatal malady at the same time.
AIDS CONTROL IN INDIA:
There have been recent developments of various HIV control programmes in India. There is extremely good amount of research and money being invested to make this disease curative and preventable and hundreds of physicians, researches, NGOs and government organizations have joined in the bandwagon to make it happen but what is needed is even more efforts, sincerity and dedication. Making antiretroviral therapy (ART) available to thousands of HIV infected patients is an extremely important part of this fight against this medical terror. With the advent of free ART for both adults and children and establishment of various dispensing centres by the government, the first step towards the goal of treatment has been achieved. However, lots more needs to be done with aspects of prevention and resistance and drug failure. In ART centres, we have good first line drugs for treatment of HIV, however in case of treatment failure; we are way behind in establishing the second line drugs. Thus facilities will have to be provided to dispense second line drugs else the ART program will fall short of ensuring that these patients are well managed.
AREAS OF CONCERN
- ARVs are toxic drugs and adequate measures to monitor side effects are essential. In the author's experience, over 30% of children on ART have adverse effects and the same are to be watched for and monitored or else we will just push a patient from one problem to the other.
- Physicians though aware about HIV still need training in the art of treating and managing these patients. Various physicians still remain confused and prescribe dual drug therapy or even monotherapy though it is known that best combination is triple drug therapy. Also physicians have commented that though they treat HIV infected patients, they are still not comfortable in proper management. Thus, just making ART available is not going to be enough but ensuring proper knowledge to physicians is equally important.
- The most important aspect that needs to be emphasized is prevention of HIV in children. The age old adage of "prevention is better than cure" remains ever true in this context. Though investments in the PPTCT programme initially may be high but the long term returns nullify the costs that an otherwise HIV infected child would incur in his lifetime. Studies have proven that HIV in children can be decreased to an extent where new cases due to vertical transmission will almost be extinct. Implementation of these protocols by various centres, institutes and even individual gynecologists & pediatricians will go a long way in establishing HIV free children in families and countries. Single dose nevirapine (NVP) that was advocated in mother and child may be beneficial in a rural setup with no other advanced medical services available. However, in institutes where better facilities are available, longer duration of ARV in mother, azt in baby for 4 weeks and no breast feeding can decrease the transmission rate to < 2% as has been seen in our patients. Aggressive approach is essential to convince and change the mindset of parents and doctors alike.
Conclusion:
Lot has been done in India regards management of HIV infected children in form of awareness and establishment of free ART but more emphasis is required on education of health care workers for proper management and most importantly implementation of prevention of vertical transmission of HIV in children. | | | | Compliance with Ethical Standards | | Funding None | | | | Conflict of Interest None | | |
- Shah I. ADVERSE EFFECTS OF ANTIRETROVIRAL THERAPY IN HIV - 1 INFECTED CHILDREN. J Trop Pediatr. 2005 Aug 26; [Epub ahead of print].
- Shah I. Is Elective Caesarian Section Really Essential for Prevention of Mother to Child Transmission of HIV in the Era of Antiretroviral Therapy and Abstinence of Breast Feeding? J Trop Pediatr. March 29, 2006 [Epub ahead of print]. [CrossRef]
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| Cite this article as: | | Shah I. HIV IN CHILDREN - WHERE DO WE STAND. Pediatr Oncall J. 2006;3: 72. |
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