Academic journal article International Public Health Journal

The Human Immunodeficiency Virus in Pediatrics

Academic journal article International Public Health Journal

The Human Immunodeficiency Virus in Pediatrics

Article excerpt

Introduction

As we enter the 4th decade of a world-wide epidemic, it is clear that few diseases have so widely shaped our world's health, economy, and society in the modern age as the Acquired Immunodeficiency Syndrome (AIDS). As of 2009 the World Health Organization (WHO) estimated that nearly 2.5 million children under 15 years of age are living with HIV, with 1,000 new infections appearing in this age group every day(1). Seven hundred children die from AIDS related diseases in the world every 24 hours and in 2009 alone a quarter of a million children under the age of 15 years, died of the disease (1-3). In areas of high prevalence of Human Immunodeficiency Virus (HIV) infection, AIDS has single-handedly reversed the progress that was made in reducing childhood mortality throughout the 20th century. In rural South Africa, for example, AIDS is currently the single largest cause of death in children less than15 years of age (4).

The history of HIV

It is now widely accepted that HIV became a human pathogen following exposure to Simian Immunodeficiency Virus (SIV) in the blood of primates in West and Central Africa at some point in the middle of the 20th century (5) (see figure 1). What is not clear is how and why this virus mutated to not only infect humans, but to become capable of human to human transmission. The SIV virus has likely been present in these primates for more than 1,000 years and humans have hunted and been exposed to their blood for centuries without the emergence of HIV (5). How and why not just one, but two versions of the HIV virus suddenly appeared at a single point in history, after years of exposure, is still the topic of much debate. The conversion of SIV into the human pathogen HIV is believed to have happened at some point in the 1950's. The first documented serologic response to HIV was found in a blood sample collected in Zaire in 1959 (6). The years of 1950 to 1970 is considered the "critical period" during which all epidemic strains of HIV emerged in Africa.

There are several theories about why the Simian viruses waited until the 20th century to mutate into HIV. Many of these theories involve the introduction of the hypodermic needle and the practice of mass, unsterile, injection practices. It is possible that HIV had occasionally emerged at several points throughout history, but was contained in small villages or rural areas and therefore, never progressed to epidemic proportions. The use of unsterile, mass, injections for immunization and antibiotic delivery may have provided the environmental pressure for an epidemic to emerge.

Additionally, there is some thought that repeated contamination of one person's blood to another, during stages of active viremia with SIV, allowed the evolutionary pressure that ultimately resulted in mutation to the human form of the virus (5). Certain 20th century changes, such as war, mass migrations, and changes in sexual practices, likely also contributed to the fast spread of this disease.

By the late 1970's doctors in Zaire and Burundi began noticing an increase in opportunistic diseases, wasting, and diarrhea among their patients (7). In 1981, doctors in California and New York had recognized an immunodeficiency syndrome in numerous patients for which they coined the term GRID (gay related immunodeficiency virus), as most of their patients, at that time, were men who have sex with men.

As time went on, the disease was recognized first in intravenous drug abusers in Haiti and then in women and children. By 1983, 3,000 infected US women and children had been identified, of which 1,000 were already dead (7). Concurrently, doctors in Uganda were battling a new and fatal disease that involved chronic diarrhea, wasting, and death that they were calling "Slim".

By the mid-1980's HIV was identified as the causative infective organism behind this fatal immunodeficiency syndrome, and doctors internationally had recognized that the new and deadly disease causing "Slim" in so many people in Sub-Saharan Africa was the same disease that Westerners were now calling AIDS. …

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