Over the last three decades, since the immunodeficiency virus (HIV) was first diagnosed, the number of children infected with HIV has dramatically increased, especially in developing countries. With the number of HIV-infected women of childbearing age rising the risk and prevalence of HIV in infants has seen a significant and shocking increase.
HIV is a retrovirus that targets the immune system and weakens people’s surveillance and defense systems against infections; it can be transmitted sexually, or via contaminated blood products, whether as a result of blood transfusions and operations or because of needle sharing; which most commonly occurs amongst intravenous drug users. Whilst awareness of the virus is on the rise, HIV that is transmitted vertically from mother to child is rarely talked about, despite the fact that this is the main route by which childhood infection occurs. Infection can occur before birth, during delivery, or after birth, with the risk of perinatal acquisition is 25%.
A viral epidemic
The WHO estimates that over 33 million individuals are infected with HIV worldwide, and 90% of them are in developing countries. Each day, 1.800 children, mostly newborns are infected with HIV and an additional 1,000 children die of HIV related causes.
An estimated 3.4 million children were living with HIV at the end of 2011, 91% of whom live in Sub-Saharan Africa. Most of these children acquire HIV from their HIV-infected mothers during pregnancy, birth or through breastfeeding. Despite the growing rates of pediatric infection, access to treatment still remains extremely low. Between 2010 and 2011 the number of children receiving anti-retroviral therapy increased by just over 100,000, despite this, coverage rates only represent 28% of those children who need of pediatric anti-retroviral therapy.
Kuwait can be characterised as a country with a low-prevalence of HIV, however, HIV is a silent epidemic and without effective awareness initiatives prevalence can multiply rapidly. Since the 1980s, when the first Kuwaiti HIV case was reported, till the end of 2011, a cumulative total of 206 Kuwaiti HIV cases has been reported, 72 percent male, 28 percent female. In the period from 2010 to 2011, 36 new Kuwaiti HIV cases were reported, 11 cases were reported in 2010 and 25 cases were reported in 2011.
The first signs of infection
It can often be extremely difficult to diagnose HIV in its early stages, particularly in infants whose immune systems are naturally weaker than adults. Usually, physicians started to suspect the viral when a child presents with frequent and severe occurrences of common childhood bacterial infections. Common infections include otitis media, sinusitis, and pneumonia, recurrent fungal infections, such as candidiasis and viral infections, such as herpes simplex or zoster infection, because HIV compromises the immune system, these children struggle to fight off simple infections; which just keep coming back. Once these symptoms start to appear it is HIV antibody detections tests are conducted. Where a child is younger than 18 months, virologic assays that directly detect HIV are required owing to the persistence of the maternal HIV antibody. Virologic assays include polymerase chain reaction (PCR) and HIV RNA assays.
In older children and adults, an enzyme-linked immunosorbent assay (ELISA) is used to detect the HIV antibody, followed by a confirmatory Western blot (which has increased specificity).1
Living with HIV
Although HIV infections threatens the lives of children, particularly in developing countries, due to the lack of access to antiretroviral therapy, appropriate anti-retroviral therapy and therapy for malignancies are critical in treating HIV positive patients. There are various classes of antiretroviral agents including nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), Protease inhibitors (PIs) and HIV integrase inhibitors. Preserving the immunity function and hindering the progression of the disease are the top priorities in treating HIV; this can be achieved through a combination of at least 3 drugs from at least 2 classes of anti-retroviral drugs.1
If properly managed patients can live for many years without HIV ever progressing to AIDS, and today, there is a promising wave of new anti-retroviral medicines under development. The U.S. Food and Drug Administration (FDA) recently approved the use of Raltegravir, an Integrase inhibitor, which is used in combination with other antiretroviral (ARV) medicines, for the treatment of HIV-1 infections in pediatric patients two years of age or older, who weigh at least 10 kg. Raltegravir is a real lifeline for children suffering from HIV, as it is currently the only approved integrase inhibitor available, for the treatment of HIV-1.
Whilst medical breakthroughs, make it easier to cope with the devastating impact the virus can have on children, preventing mother to child transmission of HIV should be a key pillar in the global response to HIV. Pediatric HIV will continue to rise, until parents are better educated about the importance of the compliance with the prescribed medical regime, health care visits and the mechanisms of HIV transmission.