LETTER TO EDITOR
|Year : 2011 | Volume
| Issue : 1 | Page : 57-58
Pediatric HIV in Mumbai
Sachee Agrawal, Sandhya Sawant, Jayanthi Shastri
Department of Microbiology, BYL Nair Charitable Hospital, Mumbai, India
|Date of Web Publication||19-May-2011|
Room no 303, Third Floor, Department of Microbiology, College Building, Nair Hospital, Mumbai Central, Mumbai - 400 008
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agrawal S, Sawant S, Shastri J. Pediatric HIV in Mumbai. Indian J Sex Transm Dis 2011;32:57-8
An estimated 2.1 million children were living with HIV/AIDS at the end of 2007. Of these, two million were living in sub-Saharan Africa. Most of these children have acquired HIV from their HIV-infected mothers during pregnancy, birth or breastfeeding. With successful interventions, the risk of mother-to-child HIV transmission can be reduced to 2%. However, such interventions are still not widely accessible or available in most resource-limited countries where the burden of HIV is highest, and an estimated 1,000 children get newly infected with HIV each day. 
In India, most initial reports in pediatric HIV infection were focused on multi-transfused recipients such as thalassemics.  With mandatory screening of blood products, the incidence of transfusion-associated HIV infection has reduced dramatically and is now seen only sporadically. In spite of this decrease, pediatric HIV infection has become an important public health issue due to a sharp rise in infection rates among women. This is particularly true for India where the major mode of transmission is heterosexual contact. 
Although the problem is well-recognized, there are scant reports on the prevalence of pediatric HIV infection from India.
This study was carried out in the Department of Microbiology at the B.Y.L Nair Charitable Hospital, Mumbai.
A total of 1,220 children (652 males and 568 females) in the age group of 18 months to 14 years, who were either walk-in clients or referred by clinicians, underwent HIV antibody testing after pre-test counseling and informed consent of guardian or parent from August 2009 to July 2010. Tests were carried out as per the guidelines laid down by the National AIDS Control Organization (NACO), India.
A total of 66 children (5.4%) were seropositive for HIV. The seroprevalence rate was highest in males, 8-14 years (50%), followed by females, 8-14 years of age (42%), and females, 18 months-3 years (33%). Mother-to-child transmission was the most common mode of infection in 63 children (95.4%). Two children gave history of blood transfusion. The mode of transmission was uncertain in one female child. A history of sexual abuse could not be elicited.
Karande et al. have reported a seroprevalence of 11.2% among hospitalized children in 2002 in Mumbai.  Parthasarathy et al, reported a prevalence of 8.9% in 2006 in New Delhi.  However, prevalence in our study was 5.4%. This fall in seroprevalence may be attributed to the effectiveness of the Prevention of Parent to Child Transmission (PPTCT) program by NACO, which was started in 2002. 
In general, pediatric HIV is not equivalent to adult HIV. Children tend to suffer from primary infections - opportunistic as well as others. While adults suffer with reactivation infections due to waning immunity as their HIV progresses,the overall progression of HIV in children is more rapid, and it tends to occur with more immature immune systems, although CD4 counts are still high. If children acquire this infection at an early age, this has prominent effects on growth and neurodevelopment. A majority of pediatric infections are perinatally acquired. Hence, early diagnosis of HIV infection among children is crucial, enabling early initiation of anti-retroviral therapy and cotrimoxazole prophylaxis,thus limiting virus multiplication and preventingsecondary infections.
| References|| |
|1.||Pediatric HIV and treatment of children living with HIV (WHO website). Available from: http://www.who.int . [Last Accessed on 2010 Sep 16]. |
|2.||Sen S, Mishra NM, Giri T, Pande I, Khare SD, Kumar A, et al. Acquired immunodeficiency syndrome (AIDS) in multitransfused children with thalassemia. Indian Pediatr 1993;30:455-60. |
|3.||Parthasarathy P, Mittal SK, Sharma VK. Prevalence of Paediatric HIV in New Delhi. Indian J Pediatr 2006;73:205-7 |
|4.||Karande S, Bhalke S, Kelkar A, Ahuja S, Kulkarni M, Mathur M. Utility of a clinically directed selective screening to diagnose HIV infection in hospitalized children in Bombay, India. J Trop Pediatr 2002;48:149-55. |
|5.||Availablefrom: http://www.nacoonline.org/National_AIDS_Control_Program/Services_for_Prevention/PPTCT . [Last Accessed on 2010 Sep 16]. |