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1st appeared 21 October 1998 A New Era for HIV-Positive Children Two factors are dramatically changing the nature of HIV and AIDS for children in the United States and other developed countries, UCSF immunologist Diane Wara told pediatricians at the American Academy of Pediatrics (AAP) annual meeting this week in San Francisco. The number of children who become infected as newborns has dropped wherever HIV-infected pregnant women receive optimal anti-retroviral treatment for their own care as well as to decrease transmission to their infants, she said. Meanwhile, the number of HIV-infected children who survive to school age and adolescence has risen wherever these children receive the new drug cocktail therapies. San Francisco's treatment program has not lost a child to AIDS in three years. "AIDS has changed from an acute disease of early infancy to a chronic illness," Wara said. "That means that treatment must take into account the psychological and social development of these children as they grow toward young adulthood."
Nationwide, the institutions in the Pediatric AIDS Clinical Trials Group (PACTG) have been able to reduce transmission of the HIV virus in utero or during birth in the communities they serve from 26 percent in 1994 to approximately five percent in 1997. In San Francisco, there has been only one case of perinatal transmission of HIV in the past three years. The model for these successful perinatal HIV programs was co-founded by Wara in the 1980s. She and colleagues in the department of obstetrics and gynecology at San Francisco General Hospital Medical Center developed the Bay Area Perinatal AIDS Center (BAPAC), the nation's first single-site program to care for HIV-positive pregnant women and their families. "We expect fewer than 500 children a year to be born with HIV in the US thanks to these programs," Wara said. "We're doing beautifully in reducing perinatal transmission nationally, and beautifully in San Francisco. But there still are many areas of the nation with large numbers of seropositive women and no centralized delivery for their care, and in those areas transmission rates still exceed five percent. In Northern California, the greater East Bay and the Central Valley are two examples." Most European nations also have been able to reduce perinatal transmission, and the number of infants with HIV is dropping in the developed world. Worldwide, however, 1.1 million children under 12 are infected with HIV. It is estimated that half a million die every year, and another half million are newly infected. "In developing nations, perinatal transmission still is at least 30 percent," Wara said. These nations have little money to test pregnant women for HIV status, and the aggressive drug therapies that have made the difference in the developed world are too expensive elsewhere. A study completed recently in Thailand shows that a shorter course of drugs can reduce the perinatal transmission rate to approximately 10 percent. That data offers some hope, Wara said, but prevention efforts in the developing world also are stymied by a dilemma: an additional 10 to 14 percent of children are infected by their mothers during breastfeeding. Yet health workers are loathe to discourage breastfeeding because it is the best way to prevent infant malnutrition. Links: Eliminating Mother-To-Child-Transmission of HIV American Academy of Pediatrics Source: Janet Basu, News Services |
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Wara is a
professor of pediatrics at UCSF and chief of pediatric
immunology/rheumatology for Lucile Packard Children's
Health Services at UCSF Stanford. She is director of the
Pediatric Clinical Research Center at UCSF and leads the
UCSF Pediatric HIV Program, which combines patient care
with research on new therapies and the resulting
reconstitution of patients' immune systems.