HIV babies: The shocking truth

Diagnosing and treating HIV infections in babies remains a challenge.

30 November 2018 | Health

JEMIMA BEUKES



Paediatric HIV/Aids treatment is facing the ongoing challenges of a lack of child formulations to fight the disease, high rates of HIV drug resistance and the inability of parents and caregivers to seek and provide daily care and support.

Without treatment, up to 50% of children born with HIV will die before their second birthday, with peak mortality at two or three months of age. The earliest possible initiation on treatment is therefore essential for saving the lives of HIV-infected infants.

Out of 23 focus countries, Namibia and South Africa leads in testing infants born to women living with HIV within eight weeks.

Both countries have recorded a testing rate of 95% compared to 1% in Angola, 51% in Kenya, 23% in India and 12% in Nigeria.

This was revealed in a recently published UNAids 2018 report titled ‘Knowledge is Power, which stresses the importance of HIV testing on World Aids Day, which is commemorated on 1 December ever year.

This year’s commemoration takes place under the theme ‘Know Your Status’.

According to the report efforts to diagnose children living with HIV and to initiate treatment remains a challenge.

“Due to the presence of maternal antibodies in infants and young children, rapid diagnostic testing is ineffective up until 18 months of age. Infants infected at or around delivery may not have a detectable level of the virus for several days or even weeks.

“In addition, the ability of nucleic acid testing to detect the virus in the blood may be affected by antiretroviral mediation taken by the mother or infant for postnatal prophylaxis or by the mother during breastfeeding, resulting in false negative results,” the report said.

It added at the same time that HIV disease progression among perinatally infected infants is much faster than among adults.

Perinatal refers to the period immediately before and after birth.

The report added that to manage these difficulties, infants with known or uncertain HIV exposure should be tested using a virological test during their first postnatal visit, which is usually at four to six weeks.

It said the insufficient availability of virological testing, the numerous visits to a health facility, as well as the time required to receive a result, also negatively affects coverage.

“In 23 focus counties, which accounted for 87% of the world’s births to women living with HIV in 2017, just 52% of newborns exposed to HIV received an HIV test within eight weeks of birth.”

Slow return of results

The report pointed out that the process of transporting samples to central laboratories from decentralised health facilities, batching blood samples for testing and returning the result to testing sites often creates long delays between the time a sample is collected and when results are received.

According to the report it takes up to 120 days for HIV test results to be returned to caregivers in Cameroon, 61 days in Zimbabwe and 97 days in Cote d’Ivoire.

However, it highlighted that point-of-care early infant diagnosis can play a vital role in starting children on treatment before the period of peak mortality at two or three months of age.

The report added that those who received point-of-care diagnosis were 40% more likely to be retained in care at 90 days

“In Malawi, for example, the introduction of point-of-care early infant diagnosis at seven health facilities reduced the time from sample collection to receipt of results by the infant’s caregiver from 56 days to less than a day.

“Among the infants diagnosed with HIV, the time between sample collection and treatment initiation was reduced from 38 days to less than a day.

“In Mozambique, 89.7% of infants living with HIV who were diagnosed with point-of-care assays initiated antiretroviral therapy within 60 days of sample collection, compared to 12.8% of children who received standard early infant diagnosis,” the report added.

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