Together with GHC CEO, Barbara Bush, find out how Men can help STOP the spread of HIV to Infants and Children: http://www.huffingtonpost.com/barbara-bush/how-can-men-help-stop-the_b_5862200.html
Last week, was it was reported that the Mississippi baby previously thought to be cured of HIV was in fact carrying detectable amounts of the virus.
The child, born in 2010 to an HIV-positive mother who received no prevention of mother-to-child transmission of HIV (PMTCT) services during her pregnancy, tested positive for HIV shortly after birth. She was given a high dose of antiretroviral medications at 30 hours of age and remained on antiretroviral therapy (ART) for 18 months before she was lost to follow-up care.
Five months after being lost to care, the child was again examined by medical staff and found to have undetectable levels of HIV, and remained so for more than two years. This was the basis of her Care and Treatment advisors declaring her cured.
This month, at almost 4 years of age, detectable levels of HIV were found in the child’s blood, along with a decreased level of CD4 T-cells and the presence of HIV antibodies—signals that the virus is actively replicating in the body. According to NIH, the baby had (16,750 copies/mL). Repeat viral load blood testing performed 72 hours later confirmed this finding (10,564 copies/mL of virus).
Additionally, the child had decreased levels of CD4+ T-cells, a key component of a normal immune system, and the presence of HIV antibodies—signals of an actively replicating pool of virus in the body. Based on these results, the child was again started on antiretroviral therapy. To date, the child is tolerating the medication with no side effects and treatment is decreasing virus levels. Genetic sequencing of the virus indicated that the child’s HIV infection was the same strain acquired from the mother.
There are a number of things that caught my attention when i read up the details on this story:
- That a mother went to deliver in the hospital, even though she had not received PMTCT services during her pregnancy – this is something for which we are yet to achieve 50% as a nation. Are we able to reverse this? Because whenever a mother does not deliver from the facility, its not only a missed opportunity to test for HIV, it means we cannot catch other birth related complications, and as such we continue to stare into grim figures of Maternal and Neonatal deaths.
- There was a lab and test kits to test for HIV, and CD4 count of the baby at the various stages of development. Is this something that we can ensure? What is the proximity of an HIV testing centre to the 2.2 million ugandan babies born annually? As you can imagine, the presence of a lab is inconsequential if the reagents and test-kits are not present. In many areas where the labs are not present, regional hubs function to carry out the tests. A sample transportation network is critical for DBS samples for exposed infants, indeed for all children and mothers.
- One of the salient successes of this story is documentation – the presence of mind to notice something unusual at your job, and you take a keen interest in it, choosing to follow it up and ask the questions that some people may consider hard to ask. I wonder if we are able to take a keen interest in something scientifically unusual and cause it to be the centre of a full fledged research, as this case turned out to be.
- How about the patience to look at the numbers (facts and figures) 4 years later? In science, this institutional memory is very important, because it makes for very interesting research findings all the time. Every picture, every story, every record, as long as it is not treated with contempt, has the potential to reveal something to us if we listen to the numbers more closely. And yes, sometimes, its years later, but if we are keen, we will hear the numbers speak to us.
As the world of science grapples with the apparent set back, players and actors in the sector remain committed to advancing HIV/AIDS research. With programs that focus on HIV prevention and treatment as the best tools to end pediatric HIV international and national partners are making great strides toward eliminating mother-to-child transmission of HIV globally.
Right now, we know, that by providing a pregnant or breastfeeding HIV positive woman ART we can almost completely eliminate the possibility that she will pass the virus onto her baby during pregnancy, child birth, or breastfeeding. However, every day 700 children become newly infected with HIV. We must quickly identify and begin treating these children to ensure they can lead healthy lives.
As a nation, our job isn’t over until no child has AIDS. Uganda must ensure that communities and health facilities have the tools they need and the resources to plan, implement, and sustain their HIV programs so that all families are reached with services. Otherwise, Uganda will never have a Mississippi Baby.
This week, I am in Kihihi, in Kanungu, South East of the Rwenzoris. Kanungu is one of the 13 districts part of the Strengthening TB and AIDS Response in South Western Uganda – STAR-SW – a USAID supported Technical Assistance Program in Uganda. STAR-SW is one of various technical assistance programs implemented by the Elizabeth Glazer Pediatric AIDS Foundations, along with 5 others – See Here.
The week, is to help us all, appreciate the work over the last 3 years, as well as to examine the cross linkages between the various programs at the district level. There are 5 technical areas that EGPAF programs support in the region: HIV Counseling and Testing (HCT), Prevention of Mother to Child Transmission (PMTCT), HIV Care & Treatment (ART C&T), Safe Male Circumcision (SMC), and Tuberculosis Interventions.
Yesterday I met 11-year old Ainamanige Collins. Distraught and visibly bothered, Collins is one of the children who turned up at an Ariel Club meeting. Ariel was a child of Elizabeth Glaser, who passed away while young because the world had not thought about Pediatric medication for HIV Positive Children. Ariel clubs are meetings specially arranged for HIV positive children, where they meet peers, get medication refills, get their CD4 Counts done and generally have fun, despite their medical condition. But Collin’s problems were not under his skin, they were in the system he was born in. 1 of 5 children, whose farmer parents are left with no option but to send him to a public school. Collins has missed most of the second school term for lack of school fees. 12000UGX per term! At the end of the day, I told Collins not to worry about school, because the God he had just prayed to, as the meeting closed, had answered his prayer for school fees for the rest of his primary school education. After 1 day, and 1 prayer, at least in Collins’ eyes, there is hope.