Challenges of Treating Kids Living With HIV

When I think of people living with HIV, it’s almost always an adult that comes to mind. But through my visits to East African countries, I’ve learned there is a growing number of children living with the virus.

Fortunately many programs now implement “prevention of mother-to-child transmission” initiatives to reduce the likelihood of newborns contracting the virus from their HIV-positive mothers during birth. But for those children who do become infected, treatment can be complicated for a number of reasons:

HIV Children

A pediatrics client shows the two Septrin he takes each day to prevent opportunistic infections. Photo by Debbie DeVoe/CRS

–       Children born to HIV-positive mothers may test positive for HIV antibodies until they are 18 months old, requiring hospitals to test instead for the actual virus in a child’s blood. This more advanced test is expensive and not always available, which can result in delayed treatment.

–       HIV patients typically begin antiretroviral treatment when their white blood cell count falls below 300, indicating an extremely weak immune system. Children under 5 years old, however, have naturally elevated levels of white blood cells for protection against disease, making the standard “CD4” test an inaccurate gauge of viral impact. Doctors rely instead on clinical assessments-checking children’s actual health and symptoms-to determine the need for antiretroviral treatment. If children miss appointments or doctors aren’t vigilant, treatment again can be delayed.

–       Pediatric HIV patients who are put on antiretroviral treatment require smaller doses, which change as weight increases through growth. Non-refrigerated liquid versions are available for patients less than 6 years old. After this age, however, children start taking adult-size tablets that their guardians must cut by one fourth, one half or three fourths depending on the child’s size and required dose. This added complexity can affect “adherence”-meaning patients take their needed medications consistently and properly.

–       Children living with HIV often aren’t living in stable homes. Sometimes they have lost one or both parents to AIDS, increasing poverty in their household. Orphans can also be shuttled between relatives struggling to stretch limited resources. If they move around frequently, they can miss regular doctor appointments and be less likely to take their medications properly.

–       While many adults decide to disclose their HIV status, most families want to protect their children from doing so. Disclosure can result in stigma and discrimination, but the decision not to disclose can also have negative consequences. Teachers may not understand when HIV-positive students have less energy or miss school. And if the children themselves haven’t been told of their status, they may question and resist taking daily medications.

Programs like CRS’ AIDSRelief initiative help improve pediatrics HIV care to let children live healthy, happy lives. Stay tuned for a story from Tanzania about this care and treatment.

– Reported by Debbie DeVoe, CRS regional information officer, East Africa

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