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Big Strides in Battle Against Pediatric AIDS

Advances help lower transmission rate in U.S., but it's a different story in developing nations

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The medications also are pricey. However, Bates said, a federal program made possible by the Ryan White CARE Act helps people who can't afford their medication get help paying for it.

Then there are the side effects. "Every medicine has side effects, and there are at least three separate medications for HIV," Bates said. "They can cause a disruption of sleep, diarrhea, and abdominal issues. They can be toxic to the kidneys and liver. The healthier people are, the better able they are to tolerate the side effects, and we have other therapies that can help minimize some of the side effects."

There's also concern about how these medications might affect growing children and their developing brains, she said.

Nonetheless, "we're very happy to have the luxury of thinking about what we need to do to make the best life for a child with HIV," Bates said. "We used to be planning for a child's death."

Children with HIV are generally well-accepted today in U.S. communities, unlike the reception some received in the past. Because most children are being treated, their viral load -- referring to the level of HIV in the blood -- is often undetectable, which means the chance of HIV transmission is very low.

"Folks in the community are probably a greater risk to a child with HIV, because of all the infections they can give them, than a child with HIV is to them," Bates said.

Yet as far as health care has come in the treatment of HIV, a cure remains elusive. In the spring, researchers reported that, for the first time, a baby had achieved long-term remission of HIV after receiving treatment for HIV within 30 hours of birth.

Though touted by some as a cure for HIV, the researchers remain cautious. At least in part, that could be because HIV doesn't act in the same way in every person, Bates explained.

"Some people have the ability to fight off the virus even without any medication, and that's a positive thing for those people and we're really looking at those people to get an idea of how we might be able to better target the virus," she said. "When we get to the point where there's a cure for HIV, I think it will be like the polio vaccine. It will still exist in some places, but it will be exceedingly rare."

In the meantime, one nearly surefire way to prevent new infections in children is to get expectant mothers who are HIV-positive on antiretroviral therapy.

"The ideal situation is for someone who knows she's HIV-positive, who has planned her pregnancy, to decrease her viral load as low as possible without medications that we don't recommend in pregnancy," said Dr. Geralyn O'Reilly, a maternal-fetal medicine specialist at Sinai Hospital in Baltimore.

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