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Eliminating Pediatric HIV/AIDS and Caring for Children with HIV

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  • 1. Eliminating Pediatric HIV/AIDS, and Caring for Children with HIV
    Dr. Laura Guay
    Vice President of Research
    Elizabeth Glaser Pediatric AIDS Foundation
    IAS 2011 Media Training & Briefing
    July 16, 2011
    Rome, Italy
  • 2. Elizabeth Glaser
  • 3. Ariel and Jake Glaser
  • 4. The Elizabeth Glaser Pediatric AIDS Foundation - 1988
  • 5. HIV Disease Course
  • 6. Diagnosis of HIV
    • HIV antibody tests
    • 7. When exposed to HIV (or any infection) the body makes antibodies to fight the infection
    • 8. Standard HIV tests measure these antibodies (EIA, rapid tests, western blot)
    • 9. HIV antibodies from an HIV-infected woman cross the placenta and enter the baby’s blood
    • 10. HIV detection tests
    • 11. These tests measure the actual parts of the HIV virus itself (PCR, p24 antigen, viral culture)
    • 12. These tests can identify HIV infection in a very young baby
  • WHO’s 4-Component Strategy for MTCT Prevention
    Prevention of HIV in women, especially young women
    Prevention of unintended pregnancies in HIV-infected women
    Prevention of transmission from an HIV- infected woman to her infant
    Support for HIV-infected women, their infants, and families
    Component
    1
    Component
    2
    Component
    3
    Component
    4
  • 13.
  • 14. 600 000
    500 000
    400 000
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    100 000
    0
    1990
    1991
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    2002
    2003
    2004
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    2006
    2007
    Year
    This bar indicates the range
    New Global HIV Infections among Children, 1990–2007
  • 15. Provision of Antiretroviral Drugs,
    2004-2009
    WHO, UNAIDS, UNICEF - Towards Universal Access: Progress Report 2009
  • 16. Review of Latest Data - 2009
    New Global HIV Infections among Children:
    370,000 children were infected with HIV –
    More than 1,000 children EVERY DAY
    Provision of Antiretroviral Drugs:
    53 % of pregnant women living with HIV received ARVs - 47% did NOT
    35% of infants born to pregnant women living with HIV received ARVs – 65% did NOT
  • 17. Benefits of Global Expansion of PMTCT Programs
    • Provides opportunity for primary prevention for large number of identified HIV-uninfected women
    • 18. Provides opportunity for prevention of HIV infection in children
    • 19. Provides opportunity for entry point into HIV Care for large number of HIV-infected women and their infected infants
    • 20. However, this is often a missed opportunity as ongoing HIV care and treatment is not available
  • If women with HIV do not take any HIV drugs during pregnancy and they breastfeed -
    - about 30 out of 100 babies born to these women will get HIV.
  • 21. Timing of HIV transmission to the infant
    During pregnancyAround labor/deliveryDuring Breastfeeding
  • 22. If women and newborns take 1 dose of the drug nevirapine around the time the baby is born -
    - only ~16 out of 100 babies will getHIV from their mothers.
  • 23. If women and newborns take a combination of HIV drugs during pregnancy and after delivery -
    - as few as 4-6 out of 100 babies will get HIV from their mothers.
  • 24. Breast Feeding vs Bottle Feeding
  • 25. 2010 Revised WHO Guidelines
  • 26. Key Changes in 2010 Revised
    WHO guidelines
    • Begin ART at CD4 cell count of 350 rather than 200
    • 27. Start ARV prophylaxis earlier in pregnancy
    • 28. Provide ARV prophylaxis during breastfeeding
    • 29. Provide single drug Nevirapine daily to infants OR
    • 30. Provide three drug ARV prophylaxis to the mother
    • 31. National authorities should decide whether MCH services will recommend HIV-infected mothers to:
    • 32. Breastfeed and receive ARV interventions OR
    • 33. Avoid all breastfeeding
    (Taking into account socioeconomics, health services, and local infant mortality and under-nutrition)
  • 34. Infant HIV diagnosis
    • Early diagnosis of HIV infection in children born to HIV-infected women is critical
    • 35. Allows early identification of children who will benefit from antiretroviral treatment, appropriate infant feeding choices, prophylaxis, and close medical follow-up
    • 36. Decreases the psychological stress of uncertainty for the parents
    • 37. HIV detection tests must be used in first 12-18 mos., then standard antibody tests are accurate
    • 38. Early infant diagnosis using dried blood spots has made services available even in remote areas
  • Infant Survival by HIV Infection Status -HIVNET 012 cohort
    Proportion alive
    Age (years)
  • 39. Goals of an HIV Care Program
    • Prevention of opportunistic infections
    • 40. Early identification of complications and their appropriate management
    • 41. Use of antiretroviral therapy to maintain and restore the immune system
    • 42. Provision of support for HIV-infected persons, including psychosocial
    • 43. Engage patients/families in HIV care and prevention through education, support and outreach
    • 44. Establish strong links to community resources
  • Basic Medical Care
    • Close Follow-Up and Health Monitoring
    - Prompt treatment of acute illnesses
    • Childhood Immunization
    • 45. Vitamin A Supplementation
    • 46. General Health Education (safe water, bednets)
    • 47. Management of Diarrhea
    • 48. Growth Monitoring & Nutrition Education
    - Early intervention/support
  • 49. WHO Indications for Initiation of ARV Therapy in Children < 2 Years
    • Initial WHO guidelines for ART in infants and children (2006) recommended starting therapy according to clinical/immunologic criteria
    • 50. Studies in infants showed that there was a ~75% decrease in death when ART was started immediately rather than waiting
    • 51. WHO revised recommendations in April 2008 such that ALL infants < 1 yr diagnosed with HIV infection should receive ART immediately
    • 52. 2010 revised WHO guidelines increased this to all infants < 2 yrs of age
  • Negotiating PMTCT Activities
    ?
  • 53. Negotiating PMTCT Activities (PMTCT = MCH)
  • 54. The Way Forward: Virtual Elimination of Pediatric HIV and AIDS worldwide
    Challenges:
    • High initial implementation costs
    • 55. Community sensitization/mobilization lacking
    • 56. Integration of PMTCT within antenatal clinics can be difficult
    • 57. Access to women who don’t deliver in health facilities
    • 58. Very low numbers of male partners involved
    • 59. Inadequate infant feeding education
    • 60. Poor postnatal follow-up
    Successes:
    • Despite the challenges in scaling up PMTCT services, we know this can be done, and we have done it
    • 61. We are making great progress worldwide, but we need to keep pushing forward to achieve universal access
  • We can…
    eliminate pediatric HIV and AIDS!

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