· Scale up early infant diagnosis

· Scale up early infant diagnosis

Detection of HIV infection in infants is crucial so that antiretroviral therapy can be started as quickly as possible. However, it is currently very difficult to test HIV in children under 18 months due to the persistence of maternal antibodies that are present for the first 18 months of the child’s life. Currently, the only way to test children under 18 months is to use a polymerase chain reaction (PCR) machine, which is a complex DNA-based diagnostic tool.

The PCR machine is expensive, requires trained परसोंnnel and advanced laboratory infrastructures – all factors that make it difficult for national programmes to use. Additionally the machines often only exist at the centralised laboratory level which means that tests carried out in rural areas need to be sent to a central structure, and the results sent back again, a process which can take between one to three months, during which time there is the risk of losing the patient to follow up. What is needed is a test that allows the mother to be informed about her baby’s HIV status within a day.

But until a more practical long term solution is found, relying on PCR remains the only option for diagnosing children under 18 months, and as such, every effort should be made by donors and implementers to ensure that it is available and used.

· Treatment – painfully slow progress

Today there remains, despite some progress, a wide gap between the range of treatment options available for adults and those for children. Of the 22 drugs approved by the U.S. Food and Drug Administration and available for adults, six do not have paediatric indications, and seven do not exist in paediatric formulations.

Drug companies were very slow to design treatments specifically formulated for children. The first paediatric fixed-dose combination (an FDC simplifies treatment by combining several drugs in one pill) to be approved by the World Health Organization (WHO), appeared six years after the adult ones. Currently there are only seven paediatric FDCs that have been quality assured by WHO or the USFDA (US Food and Drug Administration) compared with 60 for adults

Many more drugs for children could potentially exist but it is taking a painfully long time for these drugs to be studied for use on children. This process needs to be accelerated – at the moment there are simply not enough treatment options for children. If a child should develop resistance to a class of antiretrovirals there are not enough alternative medicines available, even though these drugs exist for adults.

Additionally, what is urgently needed is a good treatment for young children co-infected with tuberculosis (TB), the most common opportunistic infection in HIV. For example, efavirenz – an antiretroviral that has been registered in the U.S. since 1998 – still has no safety or efficacy data for its use in children under three. Efavirenz is particularly needed for children with HIV/AIDS who are co-infected with TB because it does not interact with TB drugs. However, until the drug is tested on children we are not able to use it.

· Not adapted to real life conditions

Of the limited number of antiretrovirals to treat HIV that do exist for children, many of them are ill-adapted to the context where the majority of HIV infected children live. Some of them are syrups that come with logistical constraints as they are heavy or require refrigeration, others are powders that need to be mixed with clean water, all factors that make them harder to use in remote settings. Other formulations have an unpleasant taste making it harder to dispense to children. When producing paediatric drugs more thought needs to be given to where those drugs will be used, and by whom.


Ensuring that children with HIV/AIDS are no longer neglected requires:

· Boosting diagnosis: more effort and funds to be placed on diagnosing children under 18 months so that treatment can be started as soon as possible
· Improving treatment: governments and other actors to start treating more paediatric HIV patients
· Accelerating drug studies for paediatric treatments: children need more treatment options to be available sooner
· Putting the constraints that exist in remote settings at the centre of the development of paediatric HIV formulations

Kids Feel...

Kids Feel...

Kids feel isolated

Children whose loved one is infected often feel "different".
Many say they cannot tell others, even professionals, that a loved one has HIV/AIDS.
They usually carry this secret alone.

Kids feel angry

Affected kids often say they are angry that HIV/AIDS has come into their families.
They are also upset by the negative comments others make about HIV/AIDS.
At times kids act out this anger through risky behaviour, like skipping school, experimenting with drugs and alcohol, and stealing.

Kids feel worried

Kids worry about what will happen to their loved ones who are infected.
They wonder "what will happen to them and me in the future?".

Kids feel loss

Grief and loss are are familiar to these kids.
Change is something they cope regularly.
Some have had a loved one die

HIV Infection and AIDS

HIV infection and AIDS both are correlated to each other. Before going to discuss about both these terms it would be better to understand the conception of HIV and AIDS. HIV stands for Human Deficiency Virus. It is a kind of virus that attacks on immune system. It exists in the CD4 cells. CD4 cells are soldier cells that resist the diseases and infections and thus keep the body protected from these invaders. However, CD4 cells can not recognize the existence of the virus as it hides in these cells. It develops gradually and replicates itself in order to damage the immune system. Once it develops completely, it takes over the immune system and destroys it completely. At the end a person becomes a victim of AIDS. Moreover when a person leads to this stage opportunistic infections attack on the immune system. They take the advantage of weakened or destroyed immune system.

On the other hand the word AIDS represents as Acquired immune deficiency syndrome. It is the advanced stage of HIV infection. When a person develops this stage he/she cannot go back to the primary stage that is known as HIV infection though he/she seems better. There are certain stages of HIV infection as a person develops these stages he/she reaches near to AIDS that is the last stage of HIV infection.

Let us see how HIV and AIDS are correlated

In order to see the correlation of these terms it would be better to see that how HIV infection turns into the AIDS. For that we will have to study the symptoms of HIV infection that once developed leads to AIDS. The symptoms of HIV can be randomly classified into two groups. The first one is early symptoms that appear when a person gets infected with HIV. The other is common symptoms that take eight to ten years to be seen.

In the US the CDC launched a series of 13 bold and frank AIDS

1994 History

In the US the CDC launched a series of 13 bold and frank AIDS advertisements breaking away from their previous low-key approach. The advertisements focused on the use of condoms, which were rarely seen or even mentioned on American television.

"One of the television ads, entitled Automatic, features a condom making its way from the top drawer of a dresser across the room and into bed with a couple about to make love. The voice-over says, 'it would be nice if latex condoms were automatics. But since they're not using them should be. Simply because a latex condom, used consistently and correctly, will prevent the spread of HIV.'"³⁴

'Your Pocket Guide to Sex' Book

In the UK, the Department of Health vetoed an AIDS campaign promoting safer sex and condoms, developed at a cost of £2 million, on the grounds that it was too explicit.³⁵ The campaign was developed by the Health Education Authority (a government funded body), who later in the year were banned by the Department of Health from distributing the book, "Your Pocket Guide to Sex".³⁶

In February the film maker Derek Jarman died of AIDS. He wrote in the preface of his autobiography:

"On 22nd of December 1986, finding I was body positive, I set myself a target: I would disclose my secret and survive Margaret Thatcher. I did. Now I have my sights on the millennium and a world where we are equal before the law."³⁷

Randy Shilts

Randy Shilts, author of the book 'And the band played on' also died in February.³⁸

In March, the actor Tom Hanks won an Oscar for playing a gay man with AIDS in the film Philadelphia.³⁹

Official statistics for Brazil, with a population of about 154 million, indicated that some 46,000 cases of AIDS had been recorded, but estimates put the actual number at anywhere between 450,000 and 3 million cases. Two thirds of the known cases were in Sao Paulo state where AIDS was the leading cause of death of women aged 20-35.⁴⁰

In France, on 7th April all the television networks, public and private, broadcast 'Tous contre le Sida' ('All against AIDS'), a special 4-hour AIDS programme. The aim was to heighten awareness about HIV/AIDS and to raise money.⁴¹ The estimated audience for the program was 33 million. Some 32,000 cases of AIDS had been recorded in France, with 15 deaths each day, and an estimated 150,000 people were thought to be infected. ⁴²

'The Flying Condom' AIDS prevention campaign, Europe

During the summer, the AIDS Prevention Agency in Brussels, in collaboration with the European Union, launched a campaign whose central image was 'the flying condom'. This was intended to serve as a visual reminder to young travellers of the risks of HIV infection. The logo was displayed in airports, railway stations, popular holiday destinations and other places young people visited during the summer.⁴³

A large European study on mother-to-child transmission showed that Caesarean section halved the rate of HIV transmission.⁴⁴

Research indicated that Thailand had reduced its rate of HIV transmission. This was largely due to action by the government, which had distributed condoms to brothels and insisted that they were used consistently; establishments that failed to comply were threatened with closure. Condom use in commercial sex had risen from 14% in 1989 to 94% in 1993.⁴⁵

By July 1994 the number of AIDS cases reported to the WHO was 985,119. The WHO estimated that the total number of AIDS cases globally had risen by 60% in the past year from an estimated 2.5 million in July 1993 to 4 million in July 1994.⁴⁶ It was estimated that worldwide there were three men infected for every two women, and that by the year 2000 the number of new infections among women would be equal to that among men.⁴⁷

At the end of July, the UN Economic and Social Council approved the establishment of a new "joint and cosponsored UN programme on HIV/AIDS" to replace the WHO's Global Programme on AIDS. The separate AIDS programmes of the UNDP, World Bank, UN Population Fund, UNICEF and UNESCO would have headquarters with the WHO in Geneva, starting in 1996.⁴⁸ Later in the year it was announced that Dr. Peter Piot, the head of the research and intervention programme within the Global Programme on AIDS, would be the head of the new UN program.⁴⁹

A study, ACTG 076, showed that AZT reduced by two thirds the risk of HIV transmission from infected mothers to their babies.⁵⁰ Somepeople believed that ACTG076 was:

“the most stunning and important result in clinical acquired immunodeficiency syndrome research to date.”⁵¹

And according to Dr Harold Jaffe of the CDC:

“It is the first indication that mother-to-child transmission of HIV can be at least decreased, if not prevented. And it will provide a real impetus for identifying more HIV-infected women during pregnancies so that they could consider the benefit of AZT treatment for themselves and their children.”The New York Times -⁵²

In early August 1994, the Tenth International Conference on AIDS was held in Yokohama, Japan. It was the first of the International Conferences to be held in Asia. No major breakthroughs emerged, and it was announced that in future the international conference would be held every two years.⁵³

Pedro Zamora

Meanwhile in the Russian Federation, deputies in the Russian Parliament, the Duma, voted at the end of October to adopt a law making HIV tests compulsory for all foreign residents, tourists, businessmen and even members of official delegations.⁵⁴

India by this time had around 1.6 million people living with HIV, up by 60% since 1993. Local and state governments were accused of underusing and misusing HIV prevention funds.⁵⁵

On 11th November AIDS killed the 22-year old Pedro Zamora. He had become famous when he appeared on MTV's 'Real World' documentary about the real lives of a group of young room mates.⁵⁶

In December, President Clinton asked Joycelyn Elders to resign from the post of US Surgeon General, following her suggestion during a World AIDS Day conference that school children should, amongst other things, be taught about masturbation. Gay activists defended the Surgeon General and criticised the president's record on AIDS. Fears were expressed that the president's action would discourage other government leaders from speaking frankly about AIDS.

WHAT ARE THE SIDE EFFECTS?

WHAT ARE THE SIDE EFFECTS?

When you start any ART, you may have temporary side effects such as headaches, high blood pressure, or a general sense of feeling ill. These side effects usually get better or disappear over time.

The most common side effects of Combivir are the same as with zidovudine (Retrovir) and lamivudine (Epivir). They include headache, upset stomach, and fatigue. See Fact Sheet 551 for more information on fatigue.

The most serious side effects of zidovudine are anemia, granulocytopenia, and myopathy. Very few people have these side effects. If they occur, your health care provider will probably have you stop using Combivir. See Fact Sheet 411 on zidovudine for more information on these side effects.

Anemia is a shortage of red blood cells caused by damage to bone marrow. Fact Sheet 552 has more information on anemia.

Granulocytopenia is a shortage of white blood cells caused by damage to bone marrow.

Myopathy is muscle pain and weakness. There is no specific treatment for myopathy.

HOW DOES COMBIVIR REACT WITH OTHER DRUGS?

Combivir can interact with other drugs or supplements you are taking. These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are constantly being identified. Make sure that your health care provider knows about ALL drugs and supplements you are taking.

Combivir should not be taken with with stavudine (Zerit®, d4T). Also, lamivudine and emtricitabine (FTC) are very similar and should not be taken together.

Blood levels of lamivudine may be increased by bactrim or septra. See Fact Sheet 535 for more information on these drugs.

Zidovudine’s side effects may be worse if you are taking several other drugs.

Methadone may increase blood levels of zidovudine. If you take combivir and methadone, watch for zidovudine side effects.

What is a window period?

What is a window period?

The ‘window period’ is a term used to describe the period of time between HIV infection and the production of antibodies. During this time, an antibody test may give a ‘false negative’ result, which means the test will be negative, even though a person is infected with HIV. To avoid false negative results, antibody tests are recommended three months after potential exposure to HIV infection.

A negative test at three months will almost always mean a person is not infected with HIV. If an individual’s test is still negative at six months, and they have not been at risk of HIV infection in the meantime, it means they are not infected with HIV.

It is very important to note that if a person is infected with HIV, they can still transmit the virus to others during the window period.

How accurate are antibody tests?

Antibody tests are extremely accurate when it comes to detecting the presence of HIV antibodies. ELISA tests are very sensitive and so will detect very small amounts of HIV antibody. This high level of sensitivity however, means that their specificity (ability to distinguish HIV antibodies from other antibodies) is slightly lowered. There is therefore a very small chance that a result could come back as ‘false positive’.

A false positive result means that although a person may not be infected with HIV, their antibody test may come back positive. All positive test results are followed up with a confirmatory test, such as:

• A Western blot assay – One of the oldest but most accurate confirmatory antibody tests. It is complex to administer and may produce indeterminate results if a person has a transitory infection with another virus.
• An indirect immunofluorescence assay – Like the Western blot, but it uses a microscope to detect HIV antibodies.
• A line immunoassay - Commonly used in Europe. Reduces the chance of sample contamination and is as accurate as the Western Blot.
• A second ELISA – In resource-poor settings with relatively high prevalence, a second ELISA test may be used to confirm a diagnosis. The second test will usually be a different commercial brand and will use a different method of detection to the first.

When two tests are combined, the chance of getting an inaccurate result is less than 0.1%.