Topic: - “Overview of AIDS in Children”

Author:-
Dr. Niyaz Ahmad Buchh.
Associate Professor (Pediatrics)
SKIMS Medical College,
Bemina, Srinagar.

Address for correspondence:-
Dr. Niyaz Ahmad Buchh,
Children’s Clinic Rainawari,
Srinagar Kashmir 190003.
Mobile:-9419478800
Pg 1/4
A).Defining HIV & AIDS:-
HIV: - Humane immunodeficiency virus is a virus that destroys part of the body’s immune system.
AIDS:-Acquired immunodeficiency syndrome is the final stage of the disease caused by HIV.
B).Epidemiology of AIDS:-
1. First case of childhood AIDS was detected in an infant in 1983.
Seropositivity of HIV in blood was noticed in 0.1-1.5% babies (ICMR Report 1988).Whereas same was noted in 8.9-9.3% multitranfused babies of thalasemia, hemophilia etc in a Delhi study 1993.
2. WHO had estimated > 42 cases of AIDS including 4 million in India by 2002.
3. 2.7 million Children are < 15 years of age.
4. 5 million new cases are to be added annually including 0.8 million children.
5. 3 million die including 58,000 children.
6. 10 million children are orphaned and estimated 20 million by 2010.
7. >90% live in developing nations and sub-Saharan areas.
It is worth to highlight pediatric AIDS because it has got unique mode of transmission, diagnostic difficulties, nonspecific clinical features and of course having high mortality because of its rapid progression and most of them die within 1st two years of life due to high viral load and depletion of infected CD4 lymphocytes in infants than adults. I n childhood AIDS usually mother is the source (symptomatic or asymptomatic) and father the cause and the child suffers due to none of his own fault. The disease seems to be disease of whole family.
C).Transmission of AIDS in Children:-
1. Vertical Transmission: Almost 90-100% children <13 years in USA and 74-86% in India acquire AIDS through vertical transmission from their mothers, also called as parent-to-child transmission (PTCT). The infection is transmitted during,
a) Antenatal period during pregnancy through placental circulation (30-40%).Virus has been detected as early as 10 weeks gestation in an aborted fetus by culture and polymerase chain reaction (PCR) within 48 hours.
b) Intrapartum period during delivery through contaminated secretions and blood in birth passage (60-70%).It is detected by culture and PCR within 4-6 weeks.
c) Postnatal period through breast feeding and have increased chances of transmission from HIV +ve mothers by 14%.It is detected by 3-6 months by culture and PCR.Chances of transmission through breast milk are high because early breast milk is moiré cellular, lacks specific HIV Ig A antibodies and rate of transmission is reduced by half on stopping breast milk.
2. Transfusion of blood products in 3-6% cases, which was more common earlier before routine screening of blood and its products was done.
3. Others like syringes and needles etc which is very rare in children.
4. Sexual Abuse:-Very rare in children, however, fast growing cause of transmission in USA in adolescent group (13-19 years).
D).Factors influencing PTCT transmission of AIDS in children:-
1. Recent infection of HIV infection.
2. Severity of HIV infection.
3. Infection with other sexually transmitted disease.
4. Obstretic procedures like vacuum extraction or forcef delivery leading to injury to body.
5. Duration of breast feeding increases risk of transmission by 14-29% if given for first 5 months of life.
6. Exclusive breast feeding or mixed feeding, since chances of intestinal epithelial damage more in mixed feeding, thus transmission of HIV infection more in mixed feeding.
7. Condition of breasts like cracked nipples, breast abscess etc.
8. Condition of baby’s mouth like abrasions, ulcers etc.

Pg 2/4
9. Provision of antiretroviral drugs.
10. Advanced maternal age increases chances of transmission.
11. Low CD4 count in mother as well as in baby.
12. High maternal viral load. If mother has <50,000 copies /ml (1.6% fold risk) compared to if >50,000 copies/ml (3.7% fold risk).
13. No antiretroviral therapy given during pregnancy, delivery and breast feeding.
14. Low antiviral antibodies in mother.
15. Preterm and low birth weight babies have 3.7 fold increased risk, if born <34 weeks of pregnancy.
16.1st born of the twin babies has 2 fold increased transmission due to more trauma and exposure to contaminated secretions in birth passage.
17. Use of illicit drugs y mother during pregnancy.
18. Delivery by Caesarian section decreases transmission by 87%, if done along with Zidovudine therapy in both mother and baby as well.
E).Feeding of baby of HIV positive mother:-
It has been observed in a study from developing country that out of 25 babies, relative risk of death due to diarrhea increases if baby is given formula feeds during 1st year of life comparing to one who is exclusively breast feed. The risk increases to 23/25,if given formula feeds during 1st 2 months of life comparing to 1/25,if exclusively breast feed. Same is increased chances of deaths due to respiratory infections in formula feed babis.Because of these complications a policy statement on HIV and infant feeding has been developed collaboratively by UNAIDS,WHO & UNICEF(1997).which says,
“AS a general principle, in all populations, irrespective of HIV infection
rates, breast feeding should continue to be protected, promoted and
supported.”
This principle holds good particularly in developing countries like India where breast feeding as recommended by WHO, should continue despite mother being HIV+ve and chances of transmission being more in breast fed babies but simultaneously the mortality and morbidity being much higher in artificially fed babies in our social set up.
F).AFASS Criteria for replacement feeding for baby of HIV positive mother:-
a) Acceptability: - Will not breast feeding stigmatize and discriminate family/mother?
b).Feasibility:- Does mother/family have adequate time skills, resources and support for correct preparations and feeding.
c).Affordability:-Can family afford purchase, preparation, storage and associated cost of preparation and feeding?
d).Sustainability:-Is continuous uninterrupted and dependable system of distribution of all products for duration of replacement feed available?
e).Safety:-Would replacement feeds be correctly and hygienically stored and prepared and fed in clean cups and pots with clean hands?
G).Breast milk feeding options by HIV+ve mothers:-
1. Exclusive breast feeding for 6 months and continued breast feeding fat least for 2 years.
2. Modified breast feeding by exclusive breast feeding for shorter duration followed by early replacement feeding by home made commercial formulas.
3. Expressed breast milk and heating it by flash method for a longer period before feeding.
4. Breast feeding by HIV-ve mother (donor’s breast milk).
All these options are discussed with the mother and if possible with the family and proper feeding advised keeping in mind various social and economic factors of the family.


Pg 3/4
H).Clinical features of childhood AIDS:-
Clinical features are nonspecific and vary from infants to older children, the latter behaving like adults. Infant may be normal at birth, or with lymphadnopathy, hepatosplenomegaly, rash, fever, recurrent diarrhea, oral thrush and chronic parotid swelling etc.
In older children almost all systems are involved, leading to progressive encephalopathy, Pneumonia, cardiomyopathy, malabsorption syndrome, renal involvement, dermatitis, anemia, Lymphoma and various opportunistic infections like tuberclosis, canadidiasis etc.
I).Diagnosis of AIDS:-
a) Clinical features but unfortunately these are nonspecific.
b) Screening of mother.
c) Immunological tests.
1. ELISA:-commonly practiced but less specific. Two successive ELISA with different proteins if +ve is suggestive of AIDS.
2. Western Blot Test:-detects antibodies to various structural proteins of virus like
Envelope:-gP160, 120, 41,
Gag:-P 55,40,24,17,
Pole:-P66, 51, 32.
WHO criteria is 2 out of 3 proteins if +ve is diagnostic, but the test is expensive and nonavailble everywhere.
3. Culture and PCR: - more helpful in perinatal AIDS and 100 % specific if done together in perinatal AIDS.
J).Prevention of childhood AIDS:-
1. Decrease maternal viral load by antiviral therapy.
a). Thai Trial advocates 300 mg of AZT from 36 weeks of pregnancy followed by 300 mg during delivery and stop breast feeding, has decreased transmission by 50%.
b). Ultra short Regimen in Uganda adopts single dose of oral Nevirapin 200 mg to mother at labour and 2 mg/kg to new born within 72 hrs of birth and relative risk is decreased by 42%. 100 countries have started this regimen.
2. Decrease exposure of fetus during delivery by performing elective Caesarian section.
3. Safer infant feeding practices as discussed above.
4. Primary prevention of AIDS by parents by avoiding extramarital sex, performing safe sex, safe syringe precautions and tested blood transfusions etc.
K).Summery of Childhood AIDS:-
a).AIDS is emerging as rapidly one of the major public health problems in India.
b).Approximately 30,000 newborn babies in India suffer due to PTCT.
c).Prevention of PTCT important strategies to decrease pediatric HIV infection.
d).Single dose Nevirapin to mother and baby at labour and within 723 hrs of birth effectively decrease vertical transmission.
e).Diagnosis of HIV very crucial with excellent laboratory back up.
f). Most rapid progression and fulminant course in infants and children.
g).Above all breast feeding to continue even by HIV+ve mothers in developing countries, however other feeding options to be adopted on individual basis.
Pg 4/4

These days we can see the level of competition is too high that it becomes very hard for the children to handle it in the right way. Do not forget their studies and extra curriculum that needs to go the parallel way. Parents too are demanding when it comes to child’s escalated success. We often see parents comparing their children with other’s children, which itself it the root cause of depression. Reality shows, publicity, fame and other kind of competitions coming in our sphere children are soft target for depression. Children don’t play well nor do they get sleep well. They are over loaded with all kind of stuff. The childhood phase in them is been wiped out at a very early stage in life. Unlike adults, children don’t exhibit sadness or express like adults do, so it becomes difficult to recognize whether a child is depressed or not. They hold back their feelings and that in turn leads to stress and depression.


Here are some symptoms that could help you identify juvenile depression.


• Being very irritable or angry or start to respond negatively on anything and everything.
• Becoming unenergetic and not responding to things where it could be fun for them.
• Feeling of not wanted or detected. (This happens usually when compared.)
• Not being able to concentrate and as a result fairing miserably at studies.
• Growth considered improper ie. Gaining and losing weight at a fast pace.
• Obesity in children.
• Crying without reason or anything and everything making them cry.
• Frequent illness.
• Feeling of “I can’t” in life.
• Mood swings. (Suicidal thoughts: take them to a qualified psychotherapist right away)


Tips to overcome juvenile depression.
• Talk to your child and make him/her understand that everyone faces depression.
• Allow the child to express.(If he/she wants to cry; let him/her cry but be with them to support their feelings with encouraging words and action).
• Make the child face the truth. We often try to cover their painful/hurtful feelings. (esp. getting the
child a prize from the shop and gifting when failing to get a prize in the competition).
• Develop confidence of the child in you. This helps them to open-up everything to you.
• Do not over empathize with the child, rather empathize to lead the child back to recovery.
• Make the child understand various other options to excel and be better.
• Schedule time for the child to eat, play and sleep. Do not encourage the child to be obese.
• Develop a hobby of child’s interest.
• Seek opinions from them for decisions at home. This is helpful in implanting a feeling of being
wanted and/or getting them mature to situations.
In spite of trying out all these if the child do not respond take him/her to a qualified psychotherapist who could assist your effort in leading the child out of situational depression.
Every child is unique and let him/her be what he/she is and excel in their field of interest. Bring the smile back on the child’s face.


Dr. Kurien S. Thomas
Executive Director
Effective Living Inc


Dr.Kurien S. Thomas is a writer, columnist, corporate trainer, psychotherapist, yoga therapist & counsellor; Founder & Executive Director of Effective Living Inc., a global counselling, k yoga & stress management clinic, which has a unique approach to psychotherapy, counselling, yoga therapy & wellness therapy. He also conducts seminars and workshops for corporate, schools, colleges and various organisations.


His personal / online counselling on family issues, teenagers, parenting, health issues, obesity, slimming, alcoholism and other issues has been a boon to many with 100 % confidentiality assured.


For more details and appointments write to him here or call at: +91-0-9969105310 or +91-0-9987223811. Website: www.effectivelivingonline.com

A Case: by
Dr. Nilesh Jitendra Shah
Bhakti Homoeopathy Dispensary, Pune – 37.
Mobile: +91 98223 93060

CASE OF CALC CARB IN ACUTE EPIDIDYMI-ORCHITIS {A Post-Op Complication After Trans-Urethral Resection Of Prostate.}

Patients Initial: S M P Age: 58 years Sex: Male
Date of Case taking: 10th Nov’08
Treating Physician: Dr. Nilesh J Shah M D (Hom)
Probable Clinical Diagnosis: Acute Epididymo-orchitis following T U R P done one & half month back (25/09/08) Clinically diagnosed with swelling redness pain etc and Routine Urine report showing abundant Pus cells within ten days of T U R P
O D P: Patient said that he was admitted for the same (Acute Epididymo-orchitis) again and was given allopathic mode of treatment and was advised by his Surgeon to take Homoeopathic medicine as he did not have relief either in pain, nor in his urine c/o, i.e. pain while urination and also Urine routine report always showed abundant Pus cells.
Patient when came on 10th Nov 08 narrated the above history and said that it all has taken very long as he is in Govt. service & about to retire, he is more worried that all the leave that he has to take now is L W P (Leave without pay) and the Surgeon has again asked him to get admitted after getting fresh Urine Culture and Sensitive report so that they can start him on fresh course of Antibiotics. He is worried and says “itna paisa kaha se lane ka” and said “ab aap hi dekho kya karma chahiye”. He was so curious about his c/o that this time he got his Urine routine report and Culture and Sensitive report done at two different place of same Urine sample as he was doubtful about the reporting that he had got earlier.

Presently on visiting he c /o
Location: Scrotum, right side
Sensation: Pain throbbing, sore
Modality: worse from Touch, Rubbing,
better byRest, Lying still

Final Prescription: CALC CARB

Potency: Calc Carb 200 single dose on 10 / 11 / 08
S L 4 pills TDS
Patient was having good susceptibility and the disease was of Acute nature.
Remedy Repetition: Single dose was prescribed
Follow up after Two days
Follow up Analysis
12 / 11 / 08
Pain less by 50 %
Anxiety while talking relieved
Did not utter about his leave
Infact asked to give him Medical certificate so that he can join his job
Confirmed doubtfulness by getting fresh Urine routine report done at three different places
Seeing the curiosity to join his job and on noticing the above fact CALC CARB 1m single dose was prescribed followed by SL
Urine report was shown on 13/11/08 Pus cells 25 – 30 / hpf which earlier was abundant
17/011/08 C / o >>> was kept on SL
22/11/08 C / o >> Patient said “tichki marlya sarkhe wat te”
Had got his Urine report done at one place only which showed Pus cells 15 – 16 / hpf
So was still kept on SL
Learning from the experience of this case
Homoeopathy works FASTEST

DO HOMEOPATHIC DRUGS CONTAIN STEROIDS ?

The answer is a definite '‘NO'’.
When appropriate Homeopathic medicines act fast & help acute conditions, people often ask or feel that the physicians are using steroids in the garb of Homoeopathy for quick results.
First of all, can steroid cure all the conditions? No, it will give only a palliative relief for the time being. Also, if you take steroids for a long time, it would induce puffiness of face ‘moon face’, excessive body hair, osteoporosis, weight increase etc. You can’t find in a single patient using Homeopathic drugs any of the above symptoms of steroid drugs. We don’t use any steroidal drugs since it is against the law of Homeopathy. i.e. steroid suppresses the immune mechanism where as Homeopathy stimulates the immune mechanism for expelling the disease.
The commonly performed test to find out steroids is the "Colorimetric Method test" which gives a false positive result for any reducing sugar & aldehyde. As you know, most homoeopaths use lactose as a base for holding the pills, containing the homeopathic remedy, together in the powders. The pills themselves are made of cane sugar, a reducing sugar. Moreover, almost all Homeopathic remedies have alcohol as a diluting agent. One can see how Homeopathic remedies, either as pills, powders or in alcohol, are likely to give a false positive test for steroids if this method is used. The best test to find out if the medicine contains steroids is the "Liberman Buchard" test, Thin Layer Chromatography Method & a UV Absorption Method. This method helps in differentiating & finding out if the substance indeed contains steroids.
Thus it is clear that before accepting a claim that the tested medicine does contain a steroid, one must find out what testing procedures were used to eliminate the possibility of a misleading result. Unsubstantiated allegations against any doctor or system of medicine are most unfair and damaging to his professional integrity and indeed to the profession.
Homeopathic medicines are completely safe and non-addictive. They can be used without any anxiety by anyone, including small babies, children, pregnant women, breast-feeding mothers, the elderly, and the chronically ill.

Gastro Esophageal Reflux Disease (GERD ) is a very common digestive disorder. Medical therapy , involving acid suppression and promotility agents are very effective for a majority of these patients but a small number of these patients do not get complete relief. Laparoscopic fundoplication is a procedure performed for patients with symptomatic GERD refractory to medical management and that which is associated with hiatal hernia .The problem lies at the junction of the esophagus and stomach where a muscular valve should prevent acid from backing upwards. If this sphincter mechanism fails, acid is free to reflux up into the food pipe and cause damage. The surgery basically augments this sphincter by wrapping a portion of the stomach known as the fundus around the lower esophageal sphincter.Before the laparoscopic approach was developed, this surgery required a large incision and the hospital stay was long. Laparoscopic fundoplication is a safe procedure, and provides less post operative morbidity in experienced hands.The fundus of the stomach which is on the left of the esophagus is wrapped around the back of the esophagus until it is once again in front of this structure.The portion of the fundus that is now on the right side of the esophagus is sutured to the portion on the left side to keep the wrap in place.The fundoplication resembles a buttoned shirt collar. The collar is the fundus wrap, and the neck represents the esophagus imbricated into the wrap.This has the effect of creating a one way valve in the esophagus to allow food to pass into the stomach, and prevent reflux of gastric acid.