Children can also be infected with HIV/AIDS

By Donya Betancourt

SANUR, Bali (JP): Right now there is an army of health professionals at war, trying to save more lives from the most deadly disease man has ever known, AIDS, the acquired immunodeficiency syndrome.

It has been 20 years since the first AIDS case was first described and diagnosed in the United States. Over the last 20 years, AIDS has become a global epidemic. In that time, 22 million people died worldwide.

According to data from the Joint United Nations Program on AIDS (UNAIDS), 4.3 million children died because of the syndrome, and there are now 36 million adults and children living with the virus.

The World Health Organization (WHO) estimated that in the year 2000 alone, 5.3 million people were newly infected with the human immunodeficiency virus (HIV), which causes AIDS, and over three million died from the deadly virus. Of the 3 million, 500,000 of them were children.

The real numbers are believed to be much higher because certain governments refuse to participate in a serious AIDS tracking and treatment program. Consequently, millions of AIDS related deaths and infections of HIV go unreported worldwide.

What is HIV or AIDS?

AIDS is a chronic, life threatening condition caused by HIV. HIV enters your body and then damages or slowly destroys the cells of your immune system. HIV interferes with your body's ability to fight off viruses, bacteria and fungi that cause disease. This makes you more susceptible to opportunistic infections your body would normally resist. A person has an HIV infection if he tests positive in a HIV- antibody test and a person has AIDS if he has latter stages of HIV infection plus its symptoms (at least one of the opportunistic infections), such as pneumocystis carinii pneumonia, CMV retinitis, toxoplasma encephalitis, herpes zoster or tumors such as Kaposi's sarcoma -- rare diseases in a healthy immune person.

Both the terms HIV and AIDS refer to the same disease.

One factor in the AIDS epidemic is the symptoms often do not appear for up to 12 years after the initial infection. HIV was initially believed to be dormant during the early phases. But actually, HIV replicates itself rapidly during all phases of infection.

What does HIV do to the human body?

The normal function of white blood cells is to destroy germs that enter your body, which is coordinated by a type of white blood cell known as CD4 lymphocytes.

Unfortunately, HIV destroys CD4 cells because HIV uses CD4 as a target to enter the cells and then use the cell's genetic machinery for self-replication. In the end, the number of CD4 cells you have progressively decreases, and you develop severe immune deficiency. This means your body is no longer able to effectively fight off viruses and bacteria that cause disease.

What are the signs and symptoms?

The symptoms of HIV and AIDS vary, depending on the phase of infection.

Early phase: HIV infection begins by it multiplying in lymph nodes and slowly destroying helper T cells. You may have no symptoms at all or may develop a flu-like illness within two to six weeks after being infected. The illness usually includes symptoms such as fever, headache, sore throat, swollen lymph nodes and a rash, and can be mistaken for other conditions. You may not realize that you have been infected with HIV.

Middle phase: It may take up to eight to nine years before HIV causes mild infections or chronic symptoms such as low-grade fever, weight loss, diarrhea and swollen lymph nodes. During this time, HIV is continuing to multiply and destroy immune cells. This stage is called symptomatic HIV infection, previously known as AIDS-related complex (ARC).

Late phase: Occurs about 10 or 11 years after the initial infection. Immunity is severely damaged by the loss of helper T cells and the body is susceptible to various opportunistic infections or tumors.

More serious symptoms may begin to appear. The symptoms include chronic diarrhea, weight loss, shaking night sweats, persistent and unexplained fatigue, high fever for several weeks, persistent headache or opportunistic infections. People with AIDS are also at great risk of developing cancers, especially Kaposi's sarcoma and lymphoma.

HIV positive children often fail to gain weight or grow normally, develop severe diarrhea, chronic thrush, and severe pneumonia with liver, spleen and lymph nodes enlargement. As the disease progresses, they may have delayed mental and physical development. Children are susceptible to the same opportunistic infections as adults and may have severe forms of common childhood illnesses such as ear infections (otitis media), pneumonia and tonsillitis.

How is HIV spread?

Transmission of HIV primarily occurs by three routes. Sexual transmission include anal or vaginal intercourse, or oral-genital sex without a condom with an HIV-positive partner. If you already have another sexually transmitted disease, you're at a much greater risk of contracting HIV.

Men can infect women more easily than women can infect men because of their organ structure. Women's organs are concentrated inside the body so women should always insist on the use of condom.

Parenteral transmission include blood transfusion, sharing contaminated needles or accidental prick of a needle used by someone with HIV.

The risk of acquiring HIV from blood transfusions, due to specialized blood screening, is extremely small. In mother-to- infant transmission, about a quarter to one-third of all untreated pregnant women with HIV will pass the infection to their babies.

Studies show that administering zidovudine (AZT) during pregnancy reduces the chances of transmitting HIV to the baby by 50 percent to 70 percent. If AZT is combined with a caesarean section, infection rates may be reduced to less than 2 percent.

How is HIV diagnosed?

HIV is usually detected by a screening test (ELISA), which checks the blood for the presence of an antibody that fights HIV. A positive result on the screening test is confirmed by another test called Western Blot. Early detection of HIV infection allows a greater chance to have appropriate treatment, thereby preserving the immune system and preventing opportunistic infections. It also should alert the person to avoid risky behavior and possibly spreading the disease.

HIV tests can be administered at most hospitals, clinics or doctors' offices.

When consulting with patients who are infected with sexually transmitted diseases (STDs), at times I am reminded of an ostrich with its head stuck in the sand. I am amazed at the number of people I interviewed who believed they were immune to the HIV/AIDS virus because of their nationality, religion or spiritual beliefs.

There is no medical or scientific evidence that the HIV/AIDS has the ability to discriminate whom it will infect. There is no known cure for the HIV/AIDS virus. The global outbreak of the HIV/AIDS virus is a concern to everyone, and everyone should behave responsibly and not put himself or others at risk. Prevention is once again the best medicine.

If you are sexually active, always use a condom and wash yourself immediately afterward. If you are taking drugs, use a clean needle and enter a rehabilitation center to help you quit your addiction. If you are already infected and pregnant, by all means, consult your health professional throughout your pregnancy and do everything required to prevent your baby from contracting the disease. This includes avoiding breastfeeding after birth.

I believe in the case of HIV/AIDS, it is true to say we need to think globally and act locally.

Next week I will discuss how to treat and prevent AIDS in children.

The writer is a pediatrician based in Sanur, Bali. Questions? Contact her at drdonya@hotmail.com or features@thejakartapost.com.