HIV Infection/AIDS In Manipur
- An Emerging Threat To Child Health -

By Dr. L Ranbir *

Human immunodeficiency virus (HIV) in fection, first recognized in 1989 in Manipur has reached epidemic proportion in this state. As of July 1996, a total of 4811 HIV infected cases have been reported of which 153 cases have developed AIDS with 41 deaths.[1]

As the epidemic progresses many women of child-bearing age are getting infected mainly through heterosexual route and a small percentage through I.V. drug abuse and transfusion of infected blood.

As a result, infants born to these infected women are increasingly infected with some of them having developed AIDS. Thus HIV /AIDS, the most serious disease to emerge in recent years is now threatening the health of hundreds of children in Manipur.

HIV infection in children was first reported in Manipur in January, 1994 and the first pediatric AIDS case was reported to the State AIDS Cell, Medical Directorate, Manipur in February, 1995. As on 31 July 1996, a total of 27 HIV infected children, 12 males and 15 females be low 10 yr of age have been reported.[1]

The exact number of the infected children who have de veloped pediatric AIDS is not known. In fact, these HIV infected children represent only a fraction of the total seropositive pediatric population in Manipur with the most severe clinical manifestations.

Considering the underdiagnosis, underreporting and delay in reporting, it is estimated that there are already few hundreds of HIV infected children in Manipur. Based on the projected population of Manipur as on 1 March 19962 and the recorded birth rate of Manipur[3],the annual estimated number of pregnant women[4] in Manipur is 52776. Among pregnant women screened anonymously without knowledge of risk status, observed seroprevalence rate in Manipur is 0.67%1 .

If we calculate at the most conservative rate of 0.6% annually over 317 HIV infected women are expected to deliver their babies in Manipur. Again, at an estimated rate of 25% mother-to-child transmission (vertical or perinatal transmission), at least 80 babies are infected perinatally with HIV annually.

It can be estimated that by the year 2000 over 600 infected chil dren will be born in Manipur and all of them will die of AIDS in due course of time. It is also expected that infants and children born to these infected women who have escaped perinatal infection will become orphans because of death of one or both of their parents..

Pediatric HIV/AIDS should be considered not as an acute condition but as the newest chronic disease with multisystem involvement.

Preliminary prospective study (unpublished) of the 7 pediatric cases admitted in RIMS Hospital, Manipur reveals that the clinical course is highly variable and infected children do not usually present with characteristic opportunistic infections but with the signs and symptoms reflecting the most common pediatric problems of our state, the characteristics of which are of ten recurrent or persistent and are poorly responsive to current available therapy.

A bimodal disease pattern has been observed :
i) an early rapidly progressive form (onset at 3-4 month) with recurrent pneumonia, hepatosplenomegaly, oropharyngeal candidiasis, diarrhoeal diseases, dermatitis followed by progressive growth failure, lymphadenopathy, wasting and encephalopathy and
ii) a slowly progressive form (onset at 2 yr) with recurrent diarrhoea and dysentery, upper respiratory symptoms, severe dermatitis with or without bacterial and fungal infections, lymphadenopathy and growth failure.

It has been observed that respiratory symptoms predominate in younger infants whereas gastrointestinal symptoms are more common in older children. These infections oc cur relatively early in the course of HIV infection and unless proper care and treatment are given death will occur in early stages of HIV caused by problems which are treatable with standard drugs.

So, in the near feature, we will be facing with the problem of having an increasing number of children with HIV/AIDS related illnesses. Tuberculosis, the leading opportunistic infection in HIV patients will be another major health problem.

In the absence of specific curative and preventive therapy, the only hope for improving the clinical situation of children with HIV infection in Manipur lies in early recognition and prompt treatment of common bacterial infections, diarrhoeal diseases, adequate nutritional management and prevention of opportunistic infections.

Pediatric HIV /AIDS will be a major health problem in Manipur in the years to come. At present, IDUs constitute 76% of the total seropositive cases in Manipur. [1] As most of the IDUs are young and as the expression of their disease may not occur for many years and with most of them getting married and with their limited willingness and ability to modify high risk sexual and drug abusing behaviour through ignorance or denial, we expect that HIV infection among women of child-bearing age will rise resulting in the corresponding increase in the number of infants acquiring HIV infection from their mothers.

This will lead to a rise in the under-five mortality rates and also in the infant mortality rates. As the AIDS epidemic expands we will observe reduction or even reversal of all the gains made in infant and childhood mortality in the last few decades through various National Child Survival Programmes.

Today, HIV/AIDS has become an inescapable fact of life. It is not only a health issue now,but also a social problem with tremendous con sequences for the well being of the individual families and the world we live in.

We have been ignoring it at great cost for too long, and we now need to recognize it as a common threat. The time has come for all of us to give greater attention to the growing epidemic and review the situ ation locally and recommend remedial steps relevant to our state which I feel, are in many ways different from those observed in other parts of the world.

L. Ranbir Singh
Assistant Professor
Department of Pediatrics
RIMS, Imphal,
Manipur.

REFERENCES

1. State AIDS Cell, Medical Directorate, Manipur, Imphal: Epidemiological analysis of HIV/AIDS in Manipur. Update, July 1996, p.p. 1-4.
2. Directorate of Economics and Statistics, Govt, of Manipur, Imphal : Projected population of Manipur 1992 -2001.
3. Directorate of Economics and Statistics, Govt, of Manipur, Imphal Vital Statistics in Statistical Abstracts of Manipur 1992, p. 34.
4. Govt, of India, Ministry of Family Welfare, MCH Division, New Delhi : National Child Survival and Safe Motherhood Programme, Training Module. Programme Intervention; Safe Motherhood, Newborn Care. New Delhi. June 1994, p.3.