How do we know if the babies of HIV-positive mums are infected? Clearly the head of the Sukabumi municipal health service (Dinas Kesehatan), Boyke Priyono, is not clear. He should be aware that the normal HIV test, which looks for antibodies, may give a positive result in such babies up to the age of 18 months. This is because babies are bequeathed all of their mother's antibodies at birth. It may take a year and a half to lose these antibodies, and replace them by it's own ones - if they are indeed infected. So a positive result prior to this is not conclusive.
There is an alternative, using a test which looks for bits of the virus, not the antibodies. This test can give a confirmed result at around six weeks of age, but as I related previously, it costs a bomb (at least for most families) and is not widely available in Indonesia. I'm sure it's rarely, if ever, used in Sukabumi.
Yet Pak Boyke is reported in today's Kompas daily as saying that they identified four babies with HIV in the town last year. "They were confirmed HIV-positive after being tested at the age of one year," he is reported as saying.
In shades of the infamous former South African Health Minister, he is also reported as saying that the babies immune system must be preserved with good nutrition. "If not, they will progress to AIDS more quickly. With control of their development and good nutrition, they will probably only progress to AIDS in adolescence."
Of course, if they are not actually infected, it may take even longer, dependent upon whether/when they join in the normal risk behaviour of adolescents here. But Pak Boyke should be aware that, if they were infected at birth, even with the best possible nutrition (beetroot anyone?), they will almost certainly need antiretrovirals before the age of ten.
One wonders what the parents of these kids have been told?
Babé
Showing posts with label Kids. Show all posts
Showing posts with label Kids. Show all posts
Wednesday, 7 January 2009
Monday, 28 July 2008
Blood spots and politics
A couple of years back, a health department official calculated that every day around ten babies are probably born with HIV in Indonesia. We still don't find many - only a total 228 have been reported as at the latest report, although there has been a 12% increase in reported cases over the last quarter! But in my travels I'm hearing of more and more cases, although clearly most cases remain undetected and contribute to the overall 35/1000 infant mortality rate here.
Babies born to HIV-positive mums inherit the mother's antibodies, and so a standard HIV test (which looks for antibodies) will show a positive result until the mother's antibodies are lost, which can take up to 18 months. So we can't be sure if a baby is infected until the age of 18 months. As a result, antiretroviral therapy (ART) is often delayed 'until we can be sure'. The problem is that, if babies are infected, the chances are high that they will die before celebrating their first birthday. (Forgive me if you already know this!)
A recent trial in Africa found that HIV-infected babies should start ART as soon as possible after birth, even if they don't show any symptoms. So a better test is urgently needed.
At a meeting late last week, the same official said the government is developing a policy that all babies born by HIV-positive mums should be tested by PCR (which looks for the virus) soon after birth. If they are found to be infected, they should be started on ART immediately. Ah, but a PCR test here costs Rp 850 thousand (almost US$100) and there are few labs with the equipment needed. Who pays?
Currently Spiritia has limited funding for this purpose - probably only enough for another 20 or so kids. But a couple of years back, we discussed this with the kindly folks in Australia. They were developing a system which could provide a diagnosis based on dried blood spots (DBS). Basically (if I understand it right), you prick the babies heel, and sop up a drop of blood onto filter paper. This paper can then be sent through the normal mail to a lab able to carry out the test, at a cost much lower than the normal PCR. The Australians even offered to do the test for free if we could send the DBS. Easy, you'd think. No transport of hazardous blood, no need for a courier, low cost.
Ah, but we forgot the politics! As you may have heard, there's been a problem with samples of bird flu virus being sent overseas. As a result, there is strict control over sending any sort of samples to other countries. So although we could start yesterday, doing so would offend against the regulations. So the testing will have to be done in country. It'll start Real Soon Now!
Babé
Babies born to HIV-positive mums inherit the mother's antibodies, and so a standard HIV test (which looks for antibodies) will show a positive result until the mother's antibodies are lost, which can take up to 18 months. So we can't be sure if a baby is infected until the age of 18 months. As a result, antiretroviral therapy (ART) is often delayed 'until we can be sure'. The problem is that, if babies are infected, the chances are high that they will die before celebrating their first birthday. (Forgive me if you already know this!)
A recent trial in Africa found that HIV-infected babies should start ART as soon as possible after birth, even if they don't show any symptoms. So a better test is urgently needed.
At a meeting late last week, the same official said the government is developing a policy that all babies born by HIV-positive mums should be tested by PCR (which looks for the virus) soon after birth. If they are found to be infected, they should be started on ART immediately. Ah, but a PCR test here costs Rp 850 thousand (almost US$100) and there are few labs with the equipment needed. Who pays?
Currently Spiritia has limited funding for this purpose - probably only enough for another 20 or so kids. But a couple of years back, we discussed this with the kindly folks in Australia. They were developing a system which could provide a diagnosis based on dried blood spots (DBS). Basically (if I understand it right), you prick the babies heel, and sop up a drop of blood onto filter paper. This paper can then be sent through the normal mail to a lab able to carry out the test, at a cost much lower than the normal PCR. The Australians even offered to do the test for free if we could send the DBS. Easy, you'd think. No transport of hazardous blood, no need for a courier, low cost.
Ah, but we forgot the politics! As you may have heard, there's been a problem with samples of bird flu virus being sent overseas. As a result, there is strict control over sending any sort of samples to other countries. So although we could start yesterday, doing so would offend against the regulations. So the testing will have to be done in country. It'll start Real Soon Now!
Babé
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