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.