Saravanan’s case is among those that have exposed the state government’s poor follow-up mechanism for children who test positive for HIV at birth. Statistics from Tamil Nadu State AIDS Control Society (Tansacs) show that of the 200 new cases of mother-to-child transmission detected in 2017, most were in the age group of 10 to 15.
The data correlates with a study published last year by the National Institute for Research in Tuberculosis. Researchers surveyed 656 children in Tamil Nadu in the 5-14 age group who registered for HIV care in 43 centres that offer antiretroviral (ARV) therapy. One in five of these children were lost to follow-up in a year.
Children less than 15 years old constitute 7% of the HIV-infected in India. More than 90% of these cases are the result of mother-to-child transmission (MTCT). Doctors can say with certainty by the 18th month if an infant has got the virus from an infected mother, HIV specialist Dr S Sundar said. “The state loses its first opportunity of preventing transmission by putting infected mothers on ARV prophylaxis too late,” he said. Adequate ARV can reduce risk of MTCT to less than 2%. It misses a second opportunity after a child is diagnosed, Dr Sundar said.
“In some instances, they may not show symptoms. There are chances that they will infect others as adults,” he said.
Doctors say early diagnosis and initiation of ART in children less than two years of age is important as failure to do so may result in early mortality. As for the rest, a study published recently by doctors from the Institute of Child Health, Egmore, offers a telling picture.
The team studied 100 children (18 months to 12 years) who were diagnosed with HIV in a government medical college in Salem: About 20% of children under the age of four died due to complications related to the disease, 25% of them had tuberculosis, 12% of them had problems with their central nervous system and 16% had blood-related disorders. Only 22 of them were asymptomatic.
Dr Murali Thandavarayan, one of the authors, said besides clinical manifestations, a majority were malnourished. “HIV in children has faster progression because of immature immunity. Early identification and management is crucial,” he said.
Officials say reasons for the loss to follow-up include unaccounted deaths, healthy children whose caregivers do not perceive the need to visit the ART centre, distance to these centres as well as the stigma involved.
“Sometimes we find it difficult to track these children as the mothers deliver in their parents’ homes,” said Dr E Suresh, who heads the ART centre in ICH.
Tansacs officials said they stepped up surveillance in the past six months. If children do not attend on the scheduled date, the outreach workers immdiately contact the family.