Infections: HIV in Children
Transcript:
Guest: Dr.
Sandra Fowler - Pediatrics
Host: Dr.
Linda Austin – Psychiatry
Dr. Linda Austin:
I’m Dr. Linda Austin. I’m interviewing
Dr. Sandra Fowler who is Associate Professor of Pediatrics here at MUSC and a
specialist in the area of infectious diseases of children. Dr. Fowler, one of your areas of interest is
HIV infection in children. Is this still
a problem in the United States?
Dr. Sandra Fowler:
It, very much, is still a problem in the United States, especially among
heterosexual women, and these are mostly women of childbearing age. And South
Carolina, in particular, has one of the highest rates
of infection in this population, compared to anywhere in the country. And, also, of new cases of HIV that are
occurring, they’re occurring in younger women, even into the teen years. So, that’s, obviously, very important, as a
pediatrician, from two areas. One is
that younger women are being infected in adolescence. That puts their children and the children of
any other woman who has HIV infection at risk for acquiring that infection from
their mother.
Dr. Linda Austin:
How are these young women acquiring HIV?
Dr. Sandra Fowler:
Well, young women are acquiring it mostly via heterosexual
transmission. That is, they have
intercourse with an infected partner and, oftentimes, that partner is much
older than the young woman. And, most of
the time, they probably don’t know their HIV infection status, though that’s
not always that case. There are
definitely some men who know their status and continue to have unprotected
sex. But, that’s the main mechanism. Some cases are due to IV drug use, but the
majority is from heterosexual transmission.
Dr. Linda Austin:
So, I guess, take-home point number one is, use protection. Insist on condoms.
Dr. Sandra Fowler:
Absolutely.
Dr. Linda Austin:
Once a woman becomes pregnant, are there special steps she should take
to determine whether she’s HIV positive, or is that routinely checked by her
doctor?
Dr. Sandra Fowler:
Well, it should be routinely checked by her doctor. It’s the standard of care in South Carolina, and in
most other states, that women are tested for HIV early on in pregnancy, along
with many other things that women are tested for in pregnancy, including
syphilis and other types of infections and other conditions. Hepatitis would also be something that a
woman would be checked for in pregnancy.
A woman can refuse that testing.
Certainly, she should be counseled to accept the testing because it has
important implications, not only for her own care. Identifying a woman who’s infected in
pregnancy can allow us to begin treatment in that mother that will prevent the
transmission of HIV infection to her infant.
Dr. Linda Austin:
At any point during the pregnancy?
Dr. Sandra Fowler:
At any point during the pregnancy, yes.
The standard recommendation would be to begin treatment beyond the first
trimester of pregnancy. The woman would
be treated during labor and then the infant receives treatment for the first
six weeks of life.
Dr. Linda Austin:
If a woman knows she’s HIV positive and wants to get pregnant, first of
all, can she safely do that, and do you continue the HIV treatment in that
first six weeks of pregnancy?
Dr. Sandra Fowler:
Well, that is a very touchy question.
Certainly, women who are HIV positive get pregnant all the time. It’s very common. Obviously, they can’t get pregnant unless
they’re having unprotected sex. So, that
means that they’re placing their partner at risk. Now, it is more efficient for a man to transmit HIV to a woman than for a woman to
transmit HIV to a man, but it still is a risk and it still occurs. So, that’s the first problem. There’s really no way around that except for,
perhaps, having artificial insemination or having a sperm donor, so that the
mom becomes pregnant without exposing a partner. So, she can certainly get pregnant. She can certainly have a successful
pregnancy, with good outcomes. But, we
do have to make sure that we take the steps that we know how to take that will
prevent transmission to an infant.
Dr. Linda Austin:
If, tragically, the HIV virus is transmitted to the infant, if one is
not aware that there’s an HIV infection, what is the danger to the baby?
Dr. Sandra Fowler:
Well, if the mother transmits the virus to the baby, that means the baby
has HIV infection. And, it’s not a death
sentence. It’s a life-long illness. For most of our patients who have the
unfortunate circumstance of being born with HIV infection, we can manage them
with very active antiretroviral therapy that we have today. You know, obviously, for us, now, it’s a
preventable disease, so we don’t want to have to do that. But, we do have effective medications that
allow our kids to go to school. We even
have kids going to college, now, that were infected at the time of birth.
Dr. Linda Austin:
That’s impressive, very exciting.
Dr. Sandra Fowler:
It is impressive. There are some
children who don’t do as well, but we have a large number who have done very
well.
Dr. Linda Austin:
Dr. Fowler, thank you so much.
Dr. Sandra Fowler:
You’re welcome.
If you have any questions about the services
or programs offered at the Medical University of South
Carolina or if you would like to schedule an
appointment with one of our physicians, please call MUSC Health
Connection: (843) 792-1414.