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Medical Resources :: General Medical Issues :: HIV Infection in Children Adopted from Abroad

What does HIV look like today? Currently, there are 30 million untreated people with AIDS in the world. "The number of untreated victims of AIDS who have died since effective drugs became available will exceed the 25 million people who died from the black death in Europe more than 600 years ago." George Watt, M.D. NEJM vol. 346, no.9 Feb 28, 2002

HIV in Vietnam
Agence France Press, Mar-13-2002
• More than half of registered prostitutes in HCMC now carry the AIDS virus
• Infection rates in Hanoi were even higher
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HIV in China
Zunyou Wu, National Center for AIDS Prevention and control, Chinese Academy of Preventive Medicine, Beijing Health Policy and Planning:16 (1): 41-46 Oxford University Press 2001
• Thousands of commercial plasma collection centers were established in counties, townships, and villages in China between 1990 and 1994, the majority in rural areas. Donating plasma for money was an easy way for rural farmers to augment income.
• HIV was spread via repeated plasma donations, transfusions, and then heterosexual spread ensued
• Lack of acknowledgment of these trends led to extensive spread all over China
• August 2001, the Chinese government acknowledged a serious AIDS crisis
• 600,000 is a serious underestimate of the number of people infected (1.5 million)
• Yunnan province drug abuse since the late 80s
• Golden Triangle--southwest China near the borders of Laos, Myanmar, and Thailand where injection drugs and needle sharing dominate
• More than a half a million people in Central China may have become infected by selling their blood in the 90s
• Henan province was the focus of recent publicity regarding the spread of AIDS in China
• New York Times series by Elizabeth Rosenthal 1999 to present exposed the AIDS crisis in China
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HIV in Eastern Europe
UNAIDS report, AIDS Epidemic Update, December 2001
• Feb 11, 2002 Reuters/Moscow Dr. Vadim Pokrovsky,head of the AIDS center, reports Russia and Ukraine HIV infection spinning out of control
• Russia 180,000 registered HIV patients
• Prevalence is reportedly over one million or 1% of adults and is still due to drugs
• More than 82 of Russian Federation’s 89 regions have now reported HIV cases
• Ukraine data 240,000 at end of 1999
• Belarus 14,000 adults and children living with HIV/AIDS by end of 1999
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HIV in India
• A few thousand in the early 90s to current estimate of about 3.8 million children and adults living with HIV/AIDS in 2001
• Heterosexual transmission dominates
• 79% of HIV infections are men
• Epidemic is shifting towards women and children
• National AIDS Control Programme 1987
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HIV Infection in Children Adopted from Abroad
• 7299 + children tested in 17 centers in the U.S. since the early 1990s
• 12 children with HIV infection (0.16%)
Russia 1
Cambodia 4
Romania 4
Panama 1
Vietnam 2
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Adoption Centers
Lisa Albers-Massachusetts 238
Jane Aronson-New York 1500
James Conway-Indiana 173
Nancy Hendrie-Maine 200
Margaret Hostetter-CT 225
Jerri Jenista-Michigan 500
Dana Johnson-Minnesota 1188
Edward Kolb-Nebraska 92
Jennifer Ladage-Missouri 81
Anna Mandalakas-Ohio 400
Laurie Miller-Massachusetts 1453
Todd Ochs-Illinois 230
Elaine Schulte-New York 150
Heidi Schwartzwald-Texas 138
Boris Skurkovich-Rhode Island ?
Sarah Springer-Pennsylvania 531
Mary Allen Staat-Ohio 300
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HIV Infection in Children Adopted from Abroad
• Russia 12 month old girl in 1998
• Cambodia all 4 negative in country
• Vietnam 2 negative in country
• Panama 1 negative in country
• Romania 2 negative in country, 2 known to be infected before adoption
• 10/12 negative at time of adoption (83%)
• 59 Children HIV ELISA positive
• 12 HIV-infected, 47 non-infected
• 59 children born to mothers with presumed HIV infection [59/7299 (0.8%)]
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HIV ELISA Positive Children Adopted from Abroad
Cambodia 20    
China 9 Guatemala 1
Russia 9 Panama 1
India 6 Ethiopia 1
Romania 4 Ukraine 1
Vietnam 3 South Korea 1
Thailand 3    
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HIV Testing in Children
• Children under 18 months may still have maternal antibody
• HIV ELISA, Western Blot, PCR, P 24 antigen, HIV culture
• Baby born to mother who is known to be infected gets HIV ELISA, WB, PCR at birth
• F/U HIV testing at one month and then between 4-6 months of age
• If the PCR test is negative at least twice then the child is considered to be negative for infection
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Dilemmas in HIV Testing of Orphans
• What happens to kids in orphanages who test HIV positive by ELISA?
• 75% of children under 2 yo. who are ELISA positive are not infected
• How to implement PCR testing?
• Quarantine? Triage? Treatment? Medical interventions?
• Agency responsibilities? Politics? Pride?
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International Pediatric Health Services, PLLC
Dr. Jane Aronson, FAAP
338 East 30th Street, #1R
New York, NY 10016
P: 212.207.6666
F: 212.207.6665
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  This page last updated February 26, 2010 1:49 AM EST