December 1 -World AIDS Prevention Day

When children become victims of HIV AIDS

By Carol Aloysius
AIDS has killed and still kills millions despite billions of funds pouring into research to find a drug capable of curing it and none has been forthcoming. It has spread across the continents leaving a trail of human suffering behind widows and widowers, parents without children, and the most pitiful of them all, orphans, some scarcely out of their mothers’ wombs.

Even though HIV/AIDS is the most rapidly growing global epidemic, its prevalence rate is still low in the South East Asian region. Nevertheless, since the population is large in these impoverished or developing countries, the factors of spreading HIV such as poverty, gender inequality and social stigma is extremely high. Therefore, the region including Sri Lanka is highly vulnerable to the epidemic.
In 2003 HIV had spread to an estimated six million people in the South East Asia Region (SEAR) - the second highest in the World after sub Saharan Africa. India, Thailand, Myanmar and Indonesia accounted for 99 % of the total burden in the region. HIV also accounted for the highest number of deaths by any single infectious agent.

Developing countries urgently need antiretroviral (ARV) treatment to keep their HIV/AIDS patients alive. Even though no cure for HIV/AIDS has been found yet, ARV drugs can dramatically reduce death rates, prolong life, improve quality of life, revitalise communities and transform HIV/AIDS from a fatal condition to a manageable chronic illness. Nevertheless, there is continuing stigma and discrimination that reduces access to diagnosis and treatment of AIDS patients in these countries, states the WHO.

Children are the worst affected. Three million people die with AIDS every year. Out of them, 500,000 are under 15 years of age. In Sri Lanka, even though a few children have been affected so far by the disease, the number is likely to rise due to the increasing number of women who are infected with AIDS by their husbands.
The Nation spoke to the Consultant Paediatrician at the Lady Ridgeway Hospital Dr. Pujitha Wickramasinghe on how risks can be minimised and treatment be made available.

Q. There has been a rise in AIDS victims especially women in Sri Lanka in recent years. What happens when an infected woman gets pregnant?
She could transmit the infection to the baby. This could happen at different stages of the pregnancy. It could happen during pregnancy, during delivery or when breastfeeding. It may not happen in each and every pregnancy, as many factors will influence it, such as stage of infection, severity of the infection, treatment already given and preventive measures adopted.

Q. What are the risks of passing the infection to a baby during pregnancy?
The risk of passing the infection to the baby, during pregnancy, is about 15 to 30% and this would increase about five to 20% if the mother decides to breastfeed the baby. This will cause an overall risk of about 20 to 45%.

Q. Can these risks be minimised? If so how?
Yes. The risk can be minimized with certain measures. Taking necessary medication during pregnancy and delivery, proper planning of the delivery, giving medication to the baby soon after birth and avoiding breastfeeding are these measures. The relevant information regarding these factors could be obtained from the relevant doctors or from the STD/HIV control units of government hospitals.

Q: What are the risks of passing the disease to a baby at the delivery? Are they greater than passing it during pregnancy?
It is difficult to give an exact figure. However, there is a high probability of infecting a baby with contaminated maternal body fluids at the point of delivery. This would be more or less similar to the probability of infecting a baby during pregnancy. Nevertheless, adopting proper preventive measures helps to reduce infection during the delivery.

Q. Can breastfeeding infects a baby even though the baby is not infected during pregnancy and delivery? What’s the percentage of such a risk?
Yes. There is five to 20% probability that a baby can get infected via breast milk compared to a non-breast-fed baby born to a HIV positive mother.

Q. What are the precautions an infected expectant mother can follow to avoid such risks?
HIV positive mothers should not breastfeed their babies. Such mothers have to be counselled and prepared during their pregnancies for alternative feeding modes. Initially, it is uninterrupted formula milk. Depending on their purchasing power, they can start the child on weaning foods after four months and reduce formula milk. However, the mother should be educated about proper sterilising techniques that should be adopted when using formula milk to avoid contamination.

Q. If the baby is infected, how long would it take the symptoms to appear?
Symptoms can occur over a variable period after birth. The average duration is about 15 to 18 months. But about 20 to 30% can have symptoms within a few months.

Q. What are these symptoms?
Initially, the symptoms are mild and non-specific. Mostly, enlarged glands (lymph nodes) in the neck, long standing or recurrent diarrhoea, poor growth and wasting and oral thrush (white plaques on tongue) are visible.

Q. Once infected, what is the treatment?
Anti viral medication and relevant antibiotics to treat any concomitant infections.

Q. How effective are these medications in prolonging the survival span?
Currently available medication cannot cure HIV. It can only control the illness, prolong lifespan and minimise related complications.

Q. What is the survival rate? How long can a HIV/AIDS infected child live?
It depends on many factors. Of the most severe cases the lifespan could be less than three years. Nevertheless, less severely affected children could live better quality lives longer, with better control and treatment.

Q: Could full blown AIDS be prevented in a child, if the disease is detected early? If so how?
HIV is the infection, and it necessarily does not mean having the disease - AIDS. Progression of HIV to AIDS depends on many physical factors and medication. Early commencement of antiretroviral therapy could prolong the development of symptoms and onset of disease.

Q. What are the medications and drugs recommended for children with AIDS?
Anti retroviral medication to control the HIV infection, and other relevant medication to treat complications, especially antibiotics to treat opportunistic infections.

Q: Does Sri Lankans have access to these drugs?
Yes. Most medications are available. Prices vary.

Q: Do Sri Lankan hospitals have special wards for HIV/AIDS patients and HIV positive babies?
No there are no such institutions or wards. This leads to discrimination and stigmatisation. Nevertheless, special care is available at any national hospital. There is no need of having special units as this illness is not spread through air, water or simple body contact other than injections, sexual contact or through open wounds. The relevant medical staff makes sure the patient’s body fluids do not contaminate the staff and other patients. Many patients who are HIV infected but do not exhibit any symptoms come into our hospital wards and the hospital staff always takes precautions to prevent cross infections. This applies not only to HIV/AIDS but also many other infectious diseases.

Q. What are the follow up programmes you have for them when they return home?
A surveillance system is in operation through the STD/HIV control programme. They visit clinics regularly and contact patients if they do not come to the clinics as recommended.

Q. How often do the mother and child have to visit the hospital once discharged?
It is difficult to specify a period. It all depends on the severity of the infection, how early interventions had been started and its response to therapy. Complications that develop and knowledge and attitude of the parents are all important factors.

Q. With more children running the risk of contracting AIDS, how can Sri Lanka prevent the disease from spreading in the future?
By giving young people a comprehensive education on reproductive health and the dangers of getting HIV if they lead high risk lives. Campaigns should be conducted to encourage them to lead healthier life styles and to offer them suitable alternatives. Ministry of Education educates adolescents about HIV/AIDS prevention. So does the STD/HIV control unit of the Ministry of health.


Aids-related deaths down twenty one per cent

BBC: Aids-related deaths are at the lowest level since their 2005 peak, down 21%, figures from UNAids suggest. Globally, the number of new HIV infections in 2010 was 21% down on that peak, seen in 1997, according to UNAids 2011 report.
The organisation says both falls have been fuelled by a major expansion in access to treatment. Its executive director, Michel Sidibe, said: “We are on the verge of a significant breakthrough.”
He added: “Even in a very difficult financial crisis, countries are delivering results in the Aids response. “We have seen a massive scale up in access to HIV treatment which has had a dramatic effect on the lives of people everywhere.”

This latest analysis says the number of people living with HIV has reached a record 34 million. Sub-Saharan Africa has seen the most dramatic improvement, with a 20% rise in people undergoing treatment between 2009 and 2010. About half of those eligible for treatment are now receiving it.
UNAids estimates 700,000 deaths were averted last year because of better access to treatment. That has also helped cut new HIV infections, as people undergoing care are less likely to infect others.
In 2010 there were an estimated 2.7 million new HIV infections, down from 3.2 million in 1997, and 1.8 million people died from Aids-related illnesses, down from 2.2m in 2005.

The figures continue the downward trend reported in previous UNAids reports.
The UN agency said: “The number of new HIV infections is 30 to 50% lower now than it would have been in the absence of universal access to treatment for eligible people living with HIV.”
Some countries have seen particularly striking improvements. In Namibia, treatment access has reached 90% and condom use rose to 75%, resulting in a 60% drop in new infections by 2010.
UNAids says the full preventive impact of treatment is likely to be seen in the next five years, as more countries improve treatment. Its report added that even if the Aids epidemic was not over: “The end may be in sight if countries invest smartly.”

The charity Medecins Sans Frontieres urged governments to keep up their funding.
MSF’s Tido von Schoen-Angerer, said: “Never, in more than a decade of treating people living with HIV/Aids, have we been at such a promising moment to really turn this epidemic around.
“Governments in some of the hardest hit countries want to act on the science, seize this moment and reverse the Aids epidemic. But this means nothing if there’s no money to make it happen.”

The International HIV/Aids Alliance said: “We welcome the ongoing commitment of UNAids to changing behaviours, changing social norms and changing laws, alongside efforts to improve access to HIV treatment. “For bigger and better impact though, we must not be complacent. There is still much more to do.”


Recipient doing well after first artificial windpipe graft

AFP: The word’s first artificial windpipe transplant has been such a success that a second operation has been carried out and a third is being planned, The Lancet reported on Thursday.

Andemariam Teklesenbet Beyene, a 36-year-old Eritrean, is doing well after undergoing the ground-breaking operation in Stockholm in June, it said. Beyene, a post-graduate geology student currently living in Reykjavik, Iceland, had had his trachea removed because of cancer.

It was replaced in a 12-hour operation on June 9 with a synthetic ‘scaffold’ covered with his own stem cells, or precursor cells of windpipe tissue. “The patient has been doing great for the last four months and has been able to live a normal life,” the British journal quoted Tomas Gudbjartsson, a professor at Landspitali University Hospital and University of Iceland in Reykjavik, as saying.
“For the last two months he has been able to focus on his studies and the plan is that he will defend his thesis at the end of this year.”

The operation, led by Professor Paolo Macchiarini of Stockholm’s Karolinska University Hospital, entailed using 3-D imaging to scan Beyene and then building a glass model of the afflicted section of his windpipe. The glass was used to shape the artificial scaffold, which was then seeded with stem cells.