Researcher calls for special care for children outside PMTCT

By Henry Neondo, Rio de Janeiro

Low weight for age, a history of bouts with tuberculosis and a viral load above 100,000 copies/ml predict poor survival in older African children with HIV, according to a study conducted in the Côte d’Ivoire and presented to the Third International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro, Brazil.

And even though antiretroviral treatment (ART) can dramatically improve the health of many children who go onto treatment, “it is not always enough,” said Dr Philippe Msellati of the Institut de Recherche pour le Développement (IRD)/Université Montpellier, France, especially if treatment isn’t started soon enough.

Dr. Msellati reported on two survival studies as well as some of the other preliminary experiences of the Programme Enfant Yopougon, which is offering treatment and care to children with HIV in Abijan, Côte d’Ivoire.

Older Children (aged over five years) with HIV Without antiretroviral treatment (ART), about half of the children with HIV in Africa die before the age of two.

But what of the rest?

Many live for years and years — in fact, according to some estimates, 30 per cent survive beyond four or five years of age.

“In the most affected countries, there are already a lot of HIV-infected children,” said Dr. Msellati.

If their risk of HIV infection wasn’t detected around the time of childbirth, the infection usually stays unidentified in most of these surviving children.

“Outside of PMTCT programmes,” said Dr. Msellati, “diagnosis of infection is rarely performed except when young children are symptomatic.”

If they come in for care of some illness after the age of three or four, health care workers do not often think to consider an HIV or AIDS related explanation.

When HIV is diagnosed in older children, “care management is often poor,” said Dr. Msellati, “without any standardization.”

Furthermore, he said that health staff may have a feeling of fatality about these children. “These children cannot be cured and for what? [why bother ?]”

In Côte d’Ivoire, there are 84,000 HIV infected children (below 15 years of age) and 15,000 children are born with HIV each year.

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