Prevention, best method against HIV/AIDS

Prevention, best method against HIV/AIDS

By Donya Betancourt

SANUR, Bali (JP): The words HIV and AIDS might grab people's
attention, but since the deadly virus may even infect infants and
children, it is best for parents to properly learn about it now
than before it is too late.

How do we know if a child is infected with the Human
Immunodeficiency Virus (HIV)?

Polymerase chain reaction (PCR) can detect small quantities of
the HIV virus in an infant's blood as early as two months of age.

How many babies are diagnosed with the virus at birth?

The HIV culture can be identified at birth in only about one-
third of infants who are actually infected with the virus. A baby
born from an HIV-positive mother can receive the HIV antibody via
the placenta and may show signs of the virus during the first 18
months after birth. If the baby does not show any signs of
infection, the HIV antibody test will be performed after 18
months of age.

How can a pregnant woman find out if she has the virus?

HIV testing can be done by blood test. The initial screening
test is called "ELISA" (enzyme-linked immunosorbent assay), which
detects antibodies specific to HIV (HIV antibody). A Western blot
test, which also measures the body's response to HIV, can more
accurately confirm the infection. However, neither the ELISA nor
the Western blot is accurate if it is performed immediately after
exposure since there is a "window period" between initial
infection and the development of positive test results. The
window period can last three months before these test results
show positive.

What do I do if the test results are positive?

The HIV RNA (ribonucleic acid) blood test can measure viral
load (the amount of HIV virus in the blood). To confirm the
diagnosis of Acquired Immuno Deficiency Syndrome (AIDS), your
doctor will take the test for CD4 cell count (a count less than
200 cells indicate AIDS).

You should be aware that not all tests are accurate.
Consequently, there are two terms to be aware of: false positive
-- a condition when you are not infected but the test is
positive; and false negative -- a condition when you are infected
but the test is negative.

When you have an HIV test, your doctor will screen with the
ELISA test. If you are negative, it means you are not infected.
But your doctor will recommend another test in the next two to
three months to discount the window period. If your screening
test is positive, your doctor will perform ELISA with two
different tests and send for Western blot to confirm the results.
If the Western blot is positive then you should be checked for
viral load and a CD4 cell count to determine the amount of immune
system damage and determine a treatment method.

Almost all HIV-infected children acquire the virus from their
mothers before or during birth, or through breast-feeding. The
mechanisms are unclear. There are various factors that affect the
transmission which depend on maternal factors, type of delivery,
the newborn itself, breast-feeding and forms of intervention used
to decrease the rate of transmission.

The risk of maternal HIV transmission is significantly
increased if the mother has advanced HIV. Vitamin A deficiency in
mothers is also associated with increased chances of
transmission. The presence of STDs with bleeding lesions on the
cervix or vagina has also proven to be a factor in the
transmission of HIV from mother to child.

The main postnatal factor is breast-feeding. An HIV positive
mother who nurses her baby can transmit the virus to her infant.
Studies suggest that breast-feeding increase the risk of HIV
transmission by approximately 10 percent to 14 percent.

Intervention

There are many types of intervention that can prevent maternal
HIV transmission. They include giving anti-retroviral drugs to
the mother during pregnancy, a caesarean section for child
delivery, avoiding breast-feeding and giving anti-retroviral
drugs to the baby.

The most successful method of intervention in decreasing
vertical transmission is the use of anti-retroviral drugs to both
mother and baby during the pregnancy, labor and postnatal period,
along with a caesarean section for delivery of the child and not
breast-feeding at all.

What is an anti-retroviral drug?

Anti-retroviral drugs aim to attack HIV at multiple points in
its reproductive cycle. Drug combinations also limit the risk of
drug-resistance. The goal is to suppress HIV RNA to undetectable
levels on follow-up blood tests.

Another common treatment approach is HAART (highly active
anti-retroviral therapy), a combination of three drugs that
include two nucleoside analogues and one protease inhibitor or
one non-nucleoside reverse transcriptase inhibitor, although many
variations of HAART exist. It is important to note that many of
these drugs have side effects, such as nausea and diarrhea. In
addition, some of them have severe drug interactions with
commonly used medications.

In conclusion, you can see that there is no axiom when we talk
about HIV/AIDS treatment.

There is no known cure and the best medical advice is once
again prevention. Be responsible and keep yourself free of risk.

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