Big Strides in Battle Against Pediatric AIDS

Advances help lower transmission rate in U.S., but it's a different story in developing nations

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By Serena Gordon
HealthDay Reporter

TUESDAY, Dec. 24 (HealthDay News) -- The effect that AIDS is having on American kids has improved greatly in recent years, thanks to effective drugs and prevention methods. The same cannot be said, however, for children worldwide.

"Maternal-to-child transmission is down exponentially [in the United States] because we do a good job at preventing it," said Dr. Kimberly Bates, director of a clinic for children and families with HIV/AIDS at Nationwide Children's Hospital in Columbus, Ohio. In fact, the chances of a baby contracting HIV from his or her mother is now less than 1 percent in the United States, according to the U.S. Centers for Disease Control and Prevention.

Still, concerns exist. "In a subset of teens, the number of infections are up," Bates said.

"We've gotten very good at minimizing the stigma and treating HIV as a chronic disease, but what goes away with the acceptance is some of the messaging that heightens awareness of risk factors," she said. "Today, people are very unclear about what their actual risk is, especially teens."

Increasing awareness of the risk of HIV, the virus that causes AIDS, is one goal that health experts hope to attain.

Across the globe, the AIDS epidemic has had a harsher effect on children, especially those in sub-Saharan Africa. According to the World Health Organization, about 3.4 million children worldwide had HIV at the end of 2011, with 91 percent of them living in sub-Saharan Africa. Children with HIV/AIDS usually acquired it from HIV-infected mothers during pregnancy, birth or breast-feeding.

Interventions that can reduce the odds of mother-to-child transmission of HIV aren't widely available in developing countries. And, the treatment that can keep the virus at bay -- known as antiretroviral therapy -- isn't available to the majority of kids living with HIV. Only about 28 percent of children who need this treatment are getting it, according to the World Health Organization.

In the United States, however, the outlook for a child or teen with HIV is much brighter.

"Every time we stop to have a discussion about HIV, the news gets better," Bates said. "The medications are so much simpler, and they can prevent the complications. Although we don't know for sure, we anticipate that most teens with HIV today will live a normal life span, and if we get to infants with HIV early, the assumption is that they'll have a normal life span."

For kids, though, living with HIV still isn't easy.

"The toughest part for most young people is the knowledge that, no matter what, they have to be on medications for the rest of their lives," she said. "If you miss a dose of diabetes medication, your blood sugar will go up, but then once you take your medicine again, it's fine. If you miss HIV medication, you can become resistant."

The medications also are pricey. However, Bates said, a federal program made possible by the Ryan White CARE Act helps people who can't afford their medication get help paying for it.

Then there are the side effects. "Every medicine has side effects, and there are at least three separate medications for HIV," Bates said. "They can cause a disruption of sleep, diarrhea, and abdominal issues. They can be toxic to the kidneys and liver. The healthier people are, the better able they are to tolerate the side effects, and we have other therapies that can help minimize some of the side effects."

There's also concern about how these medications might affect growing children and their developing brains, she said.

Nonetheless, "we're very happy to have the luxury of thinking about what we need to do to make the best life for a child with HIV," Bates said. "We used to be planning for a child's death."

Children with HIV are generally well-accepted today in U.S. communities, unlike the reception some received in the past. Because most children are being treated, their viral load -- referring to the level of HIV in the blood -- is often undetectable, which means the chance of HIV transmission is very low.