Infections: HIV in Children

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Infections: HIV in Children




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.


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