This morning’s lecture at Brigham was given by Dr. Sandra Burchett about pediatric HIV, focused primarily on domestic pediatric HIV. I am not med-peds trained but I have been interested in this issue since living in Mozambique when I saw a 13 year old HIV positive girl die of pulmonary TB. When I was at CDC, we wanted to execute an epidemiologic analysis of pediatric TB/HIV but the study never got off the ground during my two years there. A few points from today’s lecture:
- If you see an adolescent with a monospot-negative mononucleosis-like illness, think about primary HIV.
- 40-60% of HIV infected adolescents continue to engage in unprotected sex (not different from the general population). There is a high rate of substance use/smoking.
- It’s been 30 years since Ryan White was barred from school in Indiana. Yet HIV stigma remains rampant.
- She reminded us of the importance of Elizabeth Glaser’s important work on pediatric HIV.
- HIV-exposed infants must be screened by DNA PCR because of transplacental spread. The test is very specific but only 55% sensitive at birth. It is 100% sensitive by 3-6 months.
- I asked Dr. Burchett how good of a job we are doing in global pediatric HIV and gave a few examples. For example, coverage of Option B+ to reduce HIV transmission to children. The second example was the development of new, high-priority pediatric ARV co-formulations for first- and second-line treatment by 2017 being a major priority. Finally, pediatric ART coverage. There’s a long way to go, she replied.
- Andrea Ciaranello asked about HIV infected adolescents as they transition to adult care/treatment.
- Postscript– one of my colleagues pointed out this article about a 10 year old with HIV in the Washington Post.