Each year, thousands of children are born with HIV. Even though the risk of mother-to-child transmission can be reduced with treatment, medication is not widely available
Growing up with HIVPune: Reshma was just five month old when her parents brought her to hospital to find out why she had not gained weight. After a clinical examination and laboratory investigation, she was diagnosed as being HIV positive. The parents were also found to be HIV infected.
The baby was treated with anti–HIV drugs, her health started improving and her immune system normalised within a few months.
Reshma is now seven years old and looks like any other child. “She is enjoying her childhood to the fullest,” said paediatrician Jitendra Oswal, head of the paediatric HIV clinic at Bharati Hospital and Research Centre. “She is always happy to meet us and takes her medicine as a part of her diet.”
According to Prakash Sabde, state project director of the Maharashtra State AIDS Control Society (MSACS), “Maharashtra has a high number of HIV–infected patients. Mumbai has the most and is followed by Pune and then Sangli,” he said.
“Among the total number of HIV positive children, 85 to 90 per cent get the infection from their infected mother. These children are caught up in this HIV epidemic,” said Veda Purandare, senior medical officer at the ART centre at Sassoon General Hospital.
“The remaining 10 to 15 per cent get the infection from the use of blood. This includes children who require repeated blood transfusion for diseases like thalassemia or haemophilia,” said Purandare.
According to Oswal, a few cases have been documented in which the route of transmission is not known. The only effective way to prevent paediatric HIV is to reduce HIV transmission from pregnant mother to baby. “For this, our national programme of maternal and child health has to be strengthened. Also, it needs to be more effective in order to reach the masses,” said Oswal.
In India, a large number of pregnant women do not receive health care and deliver their babies at home. This puts the children at additional risk. These women should receive counselling and HIV testing, said Oswal. Pregnant mothers who are infected should also receive anti–HIV prophylactic drugs which can prevent HIV transmission to the baby, he added.
At present, the government of India provides a single dose of Nevirapine (anti-HIV drug) to the mother and baby as prophylaxis.
“This treatment can bring down the transmission to 47 per cent,” said Oswal. “However western countries use more effective regimens consisting of at least three drugs which can bring down the transmission drastically. And the threat of transmission remains just 1 to 2 per cent.” The Indian government should also adopt such a regimen, Oswal suggested.
Paediatrician Sanjay Lalwani, head of the department of paediatrics, Bharati Hospital and Research Centre, says 10 to 15 per cent of children who get the infection from their mothers die within the first two years. Eighty to 85 per cent of them develop AIDS between the ages of five and seven and die. These children are often malnourished and 50 per cent of them develop tuberculosis (TB), diarrhoea and other opportunistic infections.
The progression from HIV infection to AIDS can be prevented by treating these children with anti-HIV drugs (anti-retroviral therapy) when their immune system starts deteriorating. “The treatment may not be of much help if you start it at late stage of infection. At present, the government of India gives the drugs only to those children in the later stages of HIV infection,” said Oswal.
There are two paediatric HIV clinics dedicated to the care and treatment of HIV infected children in the state: the B J Wadia hospital for children at Parel in Mumbai and the Bharati hospital and research centre, Pune. The clinic at Bharati hospital plans to start a research project in which all HIV–infected children will receive free anti-HIV medicine and care as per guidelines of National AIDS Control Organisation (NACO).
n There are two antiretroviral therapy (ART) centres in the city at Sassoon general hospital and Yashwantrao Chavan memorial hospital (YCMH), Pimpri. Adult ART began at Sassoon in 2005, while paediatric ART started in 2006. The ART centre at YCMH was started in October 2008.
WHO global statistics
Number of people living with HIV (end of 2007): 33 million Number of children living with HIV:
Every day 1,500 children are born with HIV infection
National AIDS Control Organisation, India
Number of people living with HIV (end of 2007): 2.5 million Number of children living with HIV (end of 2007): 70,000