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Pediatric AIDS clinic reports success

Yale Medicine Magazine, 2009 - Spring


Drug protocols and other measures prevent HIV-positive births in New Haven for more than 12 years.

Born HIV-positive, for 20 years “John” relied on the Yale Pediatric AIDS Clinic to keep him healthy. That meant visits every three months and treatment that was literally hard to swallow. But John says he “loved every minute” of his time at the clinic because he could rely on the staff, even when the problem was not medical. For example, the clinic helped him find housing as a teen when his mother left the state.

Now a junior at Southern Connecticut State University, he is making plans for graduate school. He calls to let everyone at the clinic know what’s going on in his life, but he gets his HIV care at an adult clinic, where he is likely to visit three times a year. Increasingly sophisticated blood testing lets doctors fine-tune his medications to prevent resistance to antiretrovirals.

As patients like John transition into adult care, few new cases replace them. No woman known to be HIV-positive has passed on the virus to her baby in New Haven since 1996. The protocols for preventing mother-to-child transmission are so effective that the only HIV-positive infants delivered in the city over the past 13 years were born to mothers who had not been not diagnosed themselves.

“We have literally been putting ourselves out of work,” said Warren A. Andiman, M.D., FW ’76, professor of pediatrics and epidemiology and public health, and medical director of the Pediatric AIDS Program. An infectious disease specialist, Andiman began caring for HIV-positive infants in 1982. In the first few years, his young patients died protracted and miserable deaths, often by age 6. “There’s no way to describe what it was like,” he said.

Today mother-to-child transmission is a rarity in the developed world. Nationwide, the rate is less than 2 percent, which Andiman attributes to “will and money.”

Widespread HIV testing allows doctors to identify women who may pass the virus on to their babies. Any HIV-positive pregnant woman in the area gets referred to Yale’s High-Risk Maternity Program or a parallel program at the Hospital of St. Raphael, both of which work closely with the Pediatric AIDS Program. Such measures as giving mothers antiretrovirals during the pregnancy and administering AZT to mothers during labor and to newborns have proven successful, along with, in certain circumstances, performing caesarean sections and discouraging breast feeding.

Connecticut mandates that every pregnant woman be offered HIV testing twice. She can be offered testing again during labor. If she refuses, a newborn can be tested over her objections. In practice, almost all the mothers welcome testing.

During an HIV-positive woman’s pregnancy, older children or sex partners may be diagnosed and get treatment. The woman will be connected with the adult AIDS clinic and social workers will address a wide range of practical and emotional issues. “It’s a sort of seminal period, a moment when all kinds of worthwhile stuff can happen,” said Andiman.

So much good stuff has happened at the Pediatric AIDS Clinic that Andiman expects it to close in the next couple of years. The few remaining patients can be transitioned to the Pediatric Infectious Disease Clinic. “AIDS is an infectious disease just like many other infectious diseases,” Andiman said.

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