World AIDS Day
6:35 am
Wed December 1, 2010

The State of Pediatric AIDS

When the first cases of Aids started showing up, the prognosis for adults with the disease wasn't good. As children began to be born with HIV, The situation was just as dire and death rates were high.

"Early on, we didn't have much treatment we could do to prevent the infection from worsening, so it was really symptomatic care treating the infections, treating the complications, but the mortality was pretty high, and all those kids unfortunately died at a very young age," says Dr. Sherman Alter is the Director of Infectious Diseases at Children's Medical Center of Dayton.

He's been following HIV trends from the beginning, and says that early on, parents and their children were often diagnosed with HIV at the same time, and were already experiencing AIDS-related illnesses.  About 30 million people world-wise have been lost to the disease.

"If you look at even our experience here in Dayton, early on we saw a lot more kids - not a huge number, because kids always account for a small fraction of HIV infection - but we saw a greater number of kids than we do now. Most of those children present very ill, they would present in the first few years of life, and they would have an AIDS-defining condition - a serious illness," says Alter.

Today, on this World Aids Day there is better news surrounding those born with HIV. Thanks to advances in medicine, Alter says the children of mothers with HIV can be born without infection. Currently, Alter is following 16 patients - about half of those are adolescents who were born with HIV. The youngest of that group is just 5 years old. Alter says the fact that most of the latter group has reached their teenage years is significant.

"In years past, that would be unheard of - that they would be late teenagers, early twenties - but they do very well on the medicines now," says Alter.  He says that the prognosis for younger patients is difficult to discern. 

"The things that we do now as far as treatment and management are different than they will be five, ten years from now, versus five, ten years ago. We have not had a death in an individual - a child or an adolescent who is HIV infected - in about seven plus years, so I think the prognosis is good for that five-year-old, and I try to encourage him... you mention mental health... both the families and the patient... that this is now a chronic disease, it's not a fatal disease, it's akin to diabetes. You're going to have to take a medicine for the rest of your life, and maybe somewhere in the future there will be this medical breakthrough that will take care of it permanently. I think as long as they take their medicines, they try to maintain good health in other ways, and they have good follow-up with us and others, these patients do fine, so I think the prognosis is very good for these kids."

Children under 13 only account for 1 to 2 percent of all HIV infections. Dr. Alter says the focus NEEDS to be on mothers. Perinatal Transmission of the disease can be prevented. but mom's must be diagnosed and treated - and there is a series of treatments the infants need after they're born. And Alter says discussions about safe sex and HIV prevention still need to take place among adults.

The biggest rise in HIV infection rates right now is among adolescents and young adults - 14 to 24 yrs. Old. In just the last four months, the staff at Children's have treated two new cases of HIV. Both, adolescent males - One of them was already symptomatic when he was diagnosed. The other was tested after realizing he had been exposed to the disease through a partner.