Taking care of a hiv-positive baby

Pediatric AIDS means AIDS in children. It results from infection of a child with the Human Immunodeficiency Virus (HIV), which develops into full-blown Acquired Immune Deficiency Syndrome (AIDS). HIV destroys the body’s ability to fight diseases thereby putting the infected person at risk of opportunistic illnesses like tuberculosis, pneumonia, diarrhoea and herpes, which may eventually lead to death.

There are several ways in which infants and young children get infected with HIV, even though mother-to-child transmission is the most common one. It is important to bear in mind, however, that not all HIV-infected mothers pass on the virus to their babies. It is believed that up to two-thirds of babies born to HIV-positive mothers do not contract the virus.

In the past issues of Pregnant, ways in which HIV is transmitted from mother to child were explained.

In summary, these are during pregnancy, delivery and breastfeeding. In addition to these, and less common, a child can contract HIV through blood transfusion and through sexual abuse or rape.

There is an unfortunate but false belief in some communities that having sex with a virgin can cure HIV-positive men, which has led to some rape incidents involving children.

How are children tested for Aids?
Children can be tested for HIV as early as six weeks after birth, and below 18 months, with a polymerase chain result (PCR) test. This is an expensive test that shows the baby’s HIV status at an early stage. Centres without the PCR test-kit have to wait until the baby is 18 months to conduct the ordinary HIV test (Elisa test). Children below 18 months have not developed their own antibodies; they rely on those inherited from their mother at birth. From 18 months the baby develops her own antibodies. In cases of breastfeeding mothers, the tests can only be done six weeks after she has stopped breastfeeding the baby, for the results to be valid.

What care is given to HIV-positive children?
Babies born to HIV-positive mothers are categorised into three main groups.

o Babies whose mothers were on antiretrovirals (ARVs) treatment long before they even conceived.
o Babies born to mothers who were not on ARVs but were first put on treatment from seven months into pregnancy to prevent their babies from being infected.
o Babies born to mothers who had not been tested for HIV until when they were in early labour and the drug -Nevirapine, was introduced to them. It also applies to babies of mothers who did not know they were positive until after delivery. This happens especially in a case where a mother has not attended antenatal clinics where HIV would have been tested.

All babies born to these mothers are given one dose of Nevirapine syrup and a week’s dose of another drug, AZT. These are anti-HIV drugs that reduce the chance cf a newborn being infected with the virus from the mother.

The babies are introduced to Septrin syrup at six weeks to prevent them from getting opportunistic infections. Septrin is continued until the baby is tested. If the child tests negative Septrin is stopped and if positive the child takes it for life.

With good care and support, HIV-infected children can grow to become adults.

Do these children get the normal childhood immunization?
This depends on the status of the baby at the time of immunisation.
If the child has developed ful -blown AIDS the immune system is suppressed and thus cannot be introduced to live vaccines (BCG. oral polio, measles and yellow fever). This is because such immunisation will introduce the disease to the body. If the baby is given BCG, which prevents tuberculosis (TB), the baby will develop TB because the immune system is weak. In cases where the baby has not reached full blown AIDS, immunisation is given just like in any other normal child.

How are the ARVs administered to the young ones?
The mother is taught how to measure the drugs and administer them to the baby. The ARVs are given according to the baby’s weight. Every time the baby is weighed, the dosage is adjusted according to the current weight.

Are the kids given special diet?
Children with HIV must be provided with a well-balanced diet that consists of carbohydrates, proteins, vitamins, minerals salts, fats and water at all times. However, because anti-HIV drugs can cause nausea, mothers are always advised to feed the babies small but frequent food quantities.

Dr Fridah Covedi is a paediatrician based at Church House. Nairobi and has specialised in Paediatric AIDS. She can be reached at fridahgovedi@yahoo.com
END: PG 3/54