TODAY -

Call for no more new HIV infected children

Shobha Shukla *

0th International AIDS Candlelight Memorial at JN Dance Academy Hall, DM College Campus, Imphal :: May 19 2013
0th International AIDS Candlelight Memorial at JN Dance Academy Hall on May 19 2013 :: Pix - Deepak Oinam



According to UNAIDS Report 2013, an estimated 260,000 children below 18 years were newly infected with HIV in 2012 in low and middle income countries. While the first paediatric HIV case in India was recorded in 1987, in 2012 out of the 2,100,000 people living with HIV in India, 200,000 were children below 15 years.

The International Conference on “Emerging Frontiers and Challenges in Management and Control of STIs and HIV” organized by National Institute for Research in Reproductive Health (Indian Council of Medical Research) and MGM Institute of Health Sciences and being held in Mumbai, India had some very informative sessions addressing the issue of paediatric HIV.

Dr Bageshree Seth, Professor in Paediatrics, MGM Medical College and Hospital said to Citizen News Service (CNS) that paediatric HIV is different from adult HIV infection on three counts—mode of transmission, progression of disease and clinical presentation. The primary mode of transmission of HIV in children is from mother to child (85%-90%) and the rest is through transfusion of infected blood and sexual transmission. However Dr Atmaram Bandivdekar, a senior scientist at the National Institute for Research in Reproductive Health, ICMR, Mumbai, does not rule out paternal transmission of HIV, as has been seen in one case in Mumbai where an HIV infected infant was born to an HIV negative mother and HIV+ father.

In the pre HAART years 3 distinct patterns in progression of the disease in perinatally infected infants were seen—(i) in 15%-25% HIV infected children the disease showed rapid progression with symptoms evident during the first few months of life and median survival time of 6-9 months if untreated; (ii) 60%-80% new borns showed a slow progression with symptoms becoming evident by 2-3 years and a median survival time of 6 years and (iii) in less than 5% children there was minimal or no progression of the disease for 8-9 years.

Clinical manifestations present more commonly in children than adults include serious and recurrent bacterial infections, GI tract infections, chronic parotid swelling, lymphocytic interstitial pneumonitis and early onset of progressive neurologic deterioration. The most common symptoms in children with HIV as reported by many Indian studies are fever/cough lasting for more than 1 month, failure to thrive and not gaining weight, unexplained developmental delay, recurrent skin infections and diarrhoea and oral candidiasis. Other sites of infection are otitis media, skin and soft tissues and urinary tract infections. Central Nervous System manifestations are also more common in paediatric patients than in adults. The clinical manifestations may vary widely between infants, children and adolescents.

Dr Seth cautions that the clinicians should have a high index of suspicion based on clinical and non- clinical cues; confirm the diagnosis with relevant laboratory tests and initiate treatment. Diagnosis of HIV infection in infants/children less than 18 months is through RNA PCR viral cultures and boosted p24 antigen. For those above 18 months there are conventional antibody tests with three different antigenic kits.

Prevention of HIV in children is also one of the key goals of the National AIDS Control Programme of India. However, in the absence of any intervention, for every 100 pregnant HIV+ women, on an average 30 new born babies will be infected with HIV, out of which 5 will be infected during pregnancy, 15 at the time of delivery and 10 through breast feeding mostly in the early weeks. Disease progression in infants being rapid, 50% of them will die by the age of 2 years. But HIV treatment is ever evolving and is becoming simpler. A major breakthrough is less than 2% transmission from mother to child even while breast feeding. In fact, as Dr Ira Shah, a noted paediatrician of BJ Wadia Hospital for Children, Mumbai, pointed out, clinical research studies are being planned to determine whether an early course of ART in infants for a circumscribed period of time can eliminate HIV infection after it has occurred, resulting in a functional cure.

Dr Shah gave an overview of the new paediatric HIV guidelines issued by WHO in 2013. These guidelines are updates on paediatric HIV antiretroviral treatment (ART), as well as on prevention of parent to child transmission (PPTCT) for implementation in developing countries. The main recommendation in the new guidelines is to start ART in all children below 5 years of age irrespective of their CD4 count or their clinical stage, with a view to prevent ‘lost to follow up’, even though the WHO agrees that the level of evidence for this recommendation is low. Several studies, including a Cochrane review, say that there is insufficient evidence in support of either early or CD4 guided initiation of ART in HIV infected children aged 0 to 5 years. In one multicentric randomised open label study on 300 HIV infected children for early versus deferred ARV therapy for children over 1 year, results indicate higher mortality associated with starting ART at lower CD4 counts, but no significant mortality benefit from initiating ART irrespective of ART.

The second recommendation is to increase the cut off of CD4 count to <500 cells /cu mm as the criterion for starting ART in children above 5 years of age, which synchronizes with adult ART guidelines. Also, tenofovir is now included in paediatric ART schedule, especially in children above 10 years of age, where it is recommended as part of first line treatment. In fact the US FDA has approved tenofovir for use in children 2 years and above. However its effect on the bone mineral density (BMD) in growing children is undefined. Two observational studies did report a decrease in BMD in children on tenofovir, while another Italian study reported no effect. The effect on Indian children will need to be assessed in future.

The third recommendation is regarding PPTCT. The new guidelines recommend option B plus—putting all pregnant HIV+ women lifelong on triple ART consisting of tenofovir with efavirenz and either lamivudine or emtricitabine. These women can continue to breastfeed their babies and also deliver by the vaginal route. The babies are given either nevirapine or zidovudine for 6 weeks. The advantage of this method is the programmatic ease of implementation, prevention of drug resistance in the mother and continue breastfeeding they child without increase in transmission rate. Lactic acidosis in HIV negative infants exposed to long term regimens of anti retroviral therapy used for PPTCT, though rare, is a known entity. Whether prolonged exposure to anti retrovirals through breast milk will have an effect on the child will have to be assessed.

The global target is to reduce by at least 90% (using a 2009 baseline) the number of new infections among children by 2015. The UNGASS (United Nations General Assembly Special Session on HIV/AIDS) goal is for zero HIV births by 2015. Hopefully the new paediatric HIV guidelines, coupled with renewed efforts from governments and other stake holders, will provide a big leap towards controlling and preventing HIV in children. No child should suffer for the folly of adults.


* Shobha Shukla, Citizen News Service (CNS) wrote this article for e-pao.net
The writer can be contacted through Bobby Ramakant - CNS at bobby(at)ramakant(dot)org
This article was posted on May 01, 2014.


* Comments posted by users in this discussion thread and other parts of this site are opinions of the individuals posting them (whose user ID is displayed alongside) and not the views of e-pao.net. We strongly recommend that users exercise responsibility, sensitivity and caution over language while writing your opinions which will be seen and read by other users. Please read a complete Guideline on using comments on this website.




LATEST IN E-PAO.NET
  • Tarao Laimanai in Chandel #3 : Gallery
  • COVID-19 Status 23 Oct : Govt of Manipur
  • Eyek Tamba :: Learn the Manipuri script
  • Emergency Meeting on COVID-19 : Gallery
  • My memories of Imphal from 1941 #4
  • 'No need to hold Hornbill festival 2020'
  • Food for beauty :: Shahnaz Husain
  • Condemns officials of Assam govt
  • Points for new SOP
  • Beautiful : An Anal music video : Gallery
  • COVID-19 Status 22 Oct : Govt of Manipur
  • Naga Peace Process :: News Timeline
  • Attention Deficit Hyperactivity Disorder
  • The price of compassion :: Poem
  • 'Aatmanirbhar Bharat' amidst COVID-19
  • Tea in Assam
  • Politics of peace talk
  • Yubi Lakpi Manipur indigenous game: Gallery
  • COVID-19 Status 21 Oct : Govt of Manipur
  • Khundrakpam Babuchand : Sanagi Medal
  • Hringningam, Thangkhonieng: eMing
  • Myanmar's 2020 Election: The Way Forward
  • On the brink of irrelevance ?
  • Breeding & Culture Unit at Gauhati Univ
  • Ahead of high level meeting
  • Langban Lam-Haiba at Andro #1: Gallery
  • COVID-19 Status 20 Oct : Govt of Manipur
  • The aftermath of Unlock - 2
  • COVID-19 : Impact in Manipur :: News Timeline
  • Foundation Stone - Manipur Intl Univ Campus
  • Aesthetics of nature :: Poem
  • Let's talk about career
  • 'Signs of community spread'
  • Recommendation to Manipur Govt on COVID
  • COVID-19 Status 19 Oct : Govt of Manipur
  • Bhagyachandra Death Anniversary: Gallery
  • Samananda Yumnam : NEET 2020 topper
  • Resilience to minimise humanitarian crises
  • Shyam, Your Life, Is Sundarful
  • Manipur gi Ahanba Assembly Meepham
  • Partners in coalition Govt
  • Imphal valley from Tuikhang Aimol : Gallery
  • COVID-19 Status 18 Oct : Govt of Manipur
  • Indo-Naga Peace Talks : Discussion Report
  • My memories of Imphal from 1941 #3
  • 'Engage through dialogue, Refrain Violence'
  • Luminous :: Poem
  • Maya Rani Singh : NE Women Success Stories
  • Tough talk from Th Muivah
  • Nambul : The River that cries as it dies
  • COVID-19 Status 17 Oct : Govt of Manipur
  • Naga Peace parleys reach deadlock
  • Harassment of Women in Digital Space
  • Discussion : Indo-Naga Peace Talks
  • Women :: Poem
  • Kitchen ingredients to revive your hair
  • Prevalence of Domestic Violence in North East
  • COVID-19 Status 16 Oct : Govt of Manipur
  • Toll free tele-counselling for children
  • Protect our job seekers or prevent them
  • International Day of Rural Women 2020
  • Corona also kills English !
  • Webinar 'How to crack NEET [Medical]'
  • Rising number of deaths & infections
  • Downloadable Manipuri Calendar :: 2021
  • COVID-19 Status 15 Oct : Govt of Manipur
  • Chemistry Nobel Prize 2020
  • Prisoner Database Management Portal
  • Webinars: A step forward in Digital Revolution
  • My trusted friend :: Poem
  • On political acountability: Pandemic issues
  • Consultative meet sans NNPG, NSCN (IM)
  • Global Handwashing Day 2020
  • COVID-19 Status 14 Oct : Govt of Manipur
  • Looking at COVID-19 in Tamenglong
  • Groundwater TubeWell @Sinamkom : Gallery
  • 1st E/online mediation organised
  • Intl Day for Disaster Risk Reduction
  • Political Affairs Committee of NPCC
  • Projected figure of 25,000 by mid November
  • The Barefoot Legend Of India
  • COVID-19 Status 13 Oct : Govt of Manipur
  • Come by-election, COVID-19 lurking around
  • 'How to crack NEET [Medical entrance'
  • Discussion : Kuki Nationalism & Aspiration
  • To whom does it belong ? :: Poem
  • What is Plant Variety Right (PVR)?
  • High profile entry of two to BJP
  • The promised & present political scenario
  • Thang Ta @ JNMDA #2 : Gallery
  • Eyek Tamba :: Learn Manipuri script
  • For Pettigrew College in Ukhrul : An appeal
  • Tough Times Never Last But .. :: Review
  • MoU between IBSD, Imphal & Manipur Univ
  • Working with elderly as career
  • Channel wars heating up in glare of TV news
  • 100 pc : Absurdly high cut off
  • Wuyawon - flower @ Wuya Kachui : Gallery
  • COVID-19 Status 11 Oct : Govt of Manipur
  • My memories of Imphal from 1941 #2
  • Is GoM serious in building a peaceful state?
  • Fear :: Poem
  • Ice cubes for beauty
  • Training on mushroom cultivation
  • Don't deliver outside India quip
  • Evolving digital film culture in Manipur
  • COVID-19 Status 10 Oct : Govt of Manipur
  • Is NSU Conflict Sensitive ?
  • Mount Koubru: Lifeline of Saitu-Gamphazol
  • Devt & community aspiration : Chadong Case
  • The Short Stranger At Relationship :: Poem
  • Impact of Covid on Manipuri women
  • World Mental Health Day 2020
  • Thasi-Thanou, My Bipolar Mother
  • COVID-19 Status 09 Oct : Govt of Manipur
  • Raining jobs in Wangoi !
  • Admin/ Business Support @ R-Square Design
  • Father ? :: Poem
  • Agrarian reforms: Will they help farmers
  • Congratulates WFP on Nobel Peace Prize
  • Climbing death toll and infection
  • Imphal-Moreh Road & Landscape : Gallery
  • COVID-19 Status 08 Oct : Govt of Manipur
  • My memories of Imphal from 1941 #1
  • 'Jan Andolan' campaign : CM pledged [8 Oct]
  • 20 hrs refresher course on mediation
  • A memoir of good old days :: Poem
  • From bush war to politics of talks
  • Wildlife week: Raising awareness to children
  • COVID-19 Status 07 Oct : Govt of Manipur
  • International Day for Older Persons, 2020
  • Protection of Natural Resources at Molnoi
  • As I see the Invisibility :: Poem
  • Go-to-Village Mission and Job Plans
  • 'Dont levy fees from private school student'
  • Ugly stand off over NSU site
  • Ending the great Indian political farce
  • Dhol Chollom #1 : Gallery
  • COVID-19 Status 06 Oct : Govt of Manipur
  • Network marketing: good or bad ?
  • 9th AGM / Cultural Program of AMAND, Pune
  • Webinar on National Education Policy 2020
  • World Teachers' Day 2020
  • Whistle blown for five ACs
  • Banana Fest 2019, Longmai #2 : Gallery
  • COVID-19 Status 05 Oct : Govt of Manipur
  • 'May you be the mother of many sons...'
  • Dead leaves of December :: Poem
  • Assam Don Bosco Univ- 9th Convocation
  • Lecture : India-ASEAN Relations at NEHU
  • Monsoon nail trends
  • Ukhrul brutality
  • Desperate measures
  • A new look at Ta Khousaba
  • COVID-19 Status 04 Oct : Govt of Manipur
  • Trees planted - Licypriya birthday : Gallery
  • Elections during Pandemic
  • Journey that made me a School Master
  • Umeswari Barman: Success Stories from NE
  • Lakhs of trees for Licypriya birthday
  • September deadline has expired
  • Food items at Waithou Keithel #1 : Gallery
  • COVID-19 Status 03 Oct : Govt of Manipur
  • Anaemia Free Manipur Campaign : Gallery
  • Ode to Barak :: Poem
  • Myanmar visit by Foreign Secy & Army Chief
  • Why I do not support the BJP
  • 9th Convocation of Assam Don Bosco Univ
  • Covid: Heed local experts, not central politician
  • I.T Road - GoM neglected region ?
  • COVID-19 Status 02 Oct : Govt of Manipur
  • Gandhi Jayanti / Cleanliness Day : Gallery
  • What made China intrude in Eastern Ladakh
  • Please induct me as Minister
  • Is it my mind ? :: Poem
  • COVID Care Centre at Khuman Lampak
  • Unlock 2 on in Manipur
  • An apology to the event of Sept 21
  • Paddy field of Longa Koireng : Gallery
  • COVID-19 Status 01 Oct : Govt of Manipur
  • International Day of Non-Violence
  • Online refresher course on mediation
  • Tips for a healthy heart during COVID-19
  • Coffee cultivation in North-East
  • Irabot remembered on his 125th birthday
  • Unlock 5.0 : Unlocking the economy
  • Every day should be Hijam Irabot day
  • 124th Birth Anniv of Lamyanba Irabot : Gallery
  • COVID-19 Status 30 Sept : Govt of Manipur
  • Tracing how human & algae see light & colour
  • Opening of classes, desperate call of student
  • Training on mushroom at Salam Mayai Leikai
  • Dying while we live: Cry of our dying soul
  • The Future of Higher Education : Discussion
  • Wangjing Tentha, Lilong : Whistle blown
  • Uncertain future of ex-MLAs as ministers
  • How Irawat became a Marxist revolutionary
  • COVID-19 Status 29 Sept : Govt of Manipur
  • October Calendar for Year 2020 : Tools
  • Licypriya urges everyone to plant a tree
  • A roadblock to NEP 2020: Rote learning
  • Second online Lok Adalat of Manipur held
  • What lesson has Covid-19 taught us ?
  • Being the junior partner in Govt
  • Attracting tourists: few pointers..
  • Manipur Art Fest 2019 #3 : Gallery
  • Mushroom cultivation @Singjamei : Gallery
  • Ownership of mineral rights : A case study
  • My idea of justice
  • NPF Legislature meets with NEDA Convener
  • How to use glycerine on the face
  • Mantra of trace, test and treat
  • Criminalization of politics
  • Irrelevance of 66 MW Loktak Downstream HEP
  • Thangol adu maya thangu thouna hey lao-uba
  • Inauguration of Destination NE 2020 : Gallery
  • Programme on Irabot's Death Anniversary
  • RIST Popular Talk -45 : Quantum chaos
  • Salad days :: Poem
  • Last Day : Sangai Festival 2019 #2: Gallery
  • Irabot, one & only leader of oppressed mass
  • World Tourism Day 2020
  • COVID Care Centre @UNACCO #2: Gallery
  • Hijam Irawat : Irawat the Legend #3
  • We do not stop playing because we grow old
  • Swearing in @ Rajbhavan [24 Sep] : Gallery
  • Licypriya - Parliament to pass Climate Law
  • Hijam Irawat : Irawat the Legend #2
  • Petition to PM by farmers of Ningombam
  • Low ease of doing business in Manipur
  • My idea of justice
  • Offensive against party hopping
  • Politics is more than a game of numbers
  • RK Bikramjit (Flutist & Composer) : Gallery
  • Featured Front Page Photo 2020 #4: Gallery
  • Hijam Irawat : Irawat the Legend #1
  • Nurturing young minds amidst lockdown
  • Training on mushroom cultivation
  • A hot test in a Darjeeling lodge
  • Number games before reshuffle
  • Preserving biodiversity amidst uncertainty
  • Barak: Our economic & ecological security
  • Loan Distribution- Street Vendors : Gallery
  • Shirui Village, Shirui Hill, Ukhrul : Gallery
  • Tongjei Maril 1942: Bridle Path to Motor Road
  • Brahmacharimayum Roji: Actress #2 : eRang
  • COVID Care Centre @UNACCO #1: Gallery
  • Sirarakhong Hathei Phanit #3 : Gallery
  • Akhunba Takhellei #2 : Film scene :: eRang
  • 'Zehara' - Manipuri Movie :: eRang Classic
  • SPONSORED ADS