Sunday Times (Johannesburg) - December 2, 2007
Claire Keeton

Doctors have urged parents, caregivers and health workers to be alert to signs of HIV and to test children early, especially babies.

Children with HIV/Aids thrive on proper treatment, but the vast majority in South Africa are not diagnosed until it is too late, say leading HIV paediatricians.

They warn that children progress more rapidly to Aids than adults.

HIV-positive babies are four times more likely to survive if treated soon after birth, according to a revolutionary South African study, "Children with HIV Early Antiretroviral Therapy", which was conducted this year.

Dr Tammy Meyers, director of the Harriet Shezi Children's Clinic at Chris Hani Baragwanath Hospital, says: "We have known that children die in the first year without treatment and the study confirmed this.

"We need to pay attention to picking up babies very early and getting them into care quickly."

Despite the relatively small number being treated, South Africa and the rest of the continent are making progress, the Third Paediatric Aids Treatment Forum for Africa, held in Swaziland, heard this week.

Dr Paul Roux, director of the Paediatric HIV/Aids service at Groote Schuur Hospital, said: "We have indications that it is getting better.

"Most of the clinics have access to PCR testing [the technology needed for infant HIV testing] and very young children are being put in therapy.

"I recall when the youngest being treated was four years old. Now there are many clinics treating children of three months old and this is good news."

Estimates of children infected with the virus in South Africa range from about 297000 to almost twice that number.

Dr Leon Regensburg of the privately run Aid for Aids programme says it has about 3000 children on treatment, about half of whom are adolescents.

South African HIV paediatricians write in a supplement to the Journal for Infectious Diseases this month: "It is likely that a large proportion of HIV- infected children are urgently in need of access to antiretroviral treatment." About 2.3 million children in Africa have HIV - and about 130000 of them are on antiretrovirals.

Meyers, who has run an HIV clinic for children at Baragwanath Hospital for 10 years, says medical staff see dramatic improvements in children undergoing treatment.

When she started the clinic, and medicines were not yet available, most of the children used to deteriorate and die. Now her young patients are running around the corridors.

Meyers said: "It is miraculous after years of kids wasting away and dying."

One of her patients infected at birth is 20 years old and about to go to university, and the clinic treats more than 300 adolescents.

Harriet Shezi Clinic has about 2500 children on antiretrovirals, making it one of the biggest children's treatment sites in the country.

To scale up treatment, the clinic reaches out to primary health clinics, which are often the first to assess children.

Meyers says: "Primary healthcare nurses can, and do, treat children, and are good at it."

Dr Nomonde Xundu, HIV/Aids manager for the Health Department, adds that detection of children with HIV must start with the parents.

"It is most important for parents themselves to know their HIV status, particularly those with infants and children.

"We have PCR testing in most facilities for six-week-old infants. Those with HIV should get cotrimoxazole from six weeks."

This antibiotic helps protect against pneumonia and chest infections - common killers - and to some extent against diarrhoea. Using cotrimoxazole reduces death among HIV-infected children by as much as 43%, studies show.

While all these steps will help fight HIV among children, the first priority in ending the children's epidemic is to scale up the Preventing Mother to Child Transmission programme.

Treatment Action Campaign spokesman Nathan Geffen says: "The PMTCT programme is the litmus test by which we must judge the government's National Strategic Plan.

"We have about 60000 new infections a year ... and we can bring this down to a couple of hundred. We can wipe out the paediatric epidemic with political will."

HIV has been virtually eradicated among children in the US and Britain.

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