Outcome of children born to HIV positive mothers

INTRODUCTION: Acquired Immuno Deficiency Syndrome (AIDS) is one of the most feared pandemic infections of the present world, which brought out hitherto unheard infections into limelight. The World Health Organization (WHO) estimated that more than 39 million persons were living with HIV infection at the end of 2004, including 2.2 million children. AIDS is caused by the Human immuno deficiency virus (HIV), which was first discovered by Robert Gallo in 1981. HIV-1 and HIV-2 are RNA viruses belonging to the family of Retroviridia of genus Lentivirus. HIV-1 is divided into three major groups namely M, O, and N and further into subtypes. Group M (Major) is divided into 9 subtypes of which subtype `C' is commonly found. AIM OF THE STUDY: To Study the outcome of children born to HIV positive mothers in terms of morbidity, mortality and HIV status at follow-up up to 18 months of age. METHODOLOGY: STUDY DESIGN: Cohort study. STUDY PLACE: Institute of Obstetrics and Gynecology, Chennai, Institute of Child Health and Hospital for Children, Chennai. STUDY PERIOD: Oct 2006 to Oct 2008. POPULATION: Study Cohort- 50 Babies born to HIV sero positive Mothers. Control Cohort- 100 Babies born to HIV sero negative Mothers. MANOEUVRE: The study was conducted in the Institute of Obstetrics and Gynecology, Institute of Child Health and Hospital for children, Chennai. Fifty babies born to HIV positive mothers and 100 babies born to HIV negative mothers were enrolled in the study from the post-natal ward, after obtaining consent for participation in the study. Immediately after birth the newborn were given single dose of syrup. Nevirapine 2 mg/kg per oral. Maternal details were obtained from their case records. Maternal morbidity pattern were compared between HIV positive and negative mothers. The mothers were detected as HIV positive either previously or ante-natally, they were started on HAART (highly active anti retro viral therapy) based on clinical and laboratory parameters. Comparision of various maternal parameters were done between HIV positive and negative mothers. The maternal morbidities analyzed were Anemia – defined as hemoglobin concentration <11 gm/100ml. PIH – defined as blood pressure more than 140/90 mmHg and proteinuria detected after 20 weeks of gestation in a previously normal woman. GDM – defined as abnormal carbohydrate tolerance with onset or first detected during pregnancy as evidenced by abnormal glucose tolerance test. SUMMARY: Thus our study on the outcome of HIV exposed babies has the following findings: No. of HIV exposed babies studied = 50. No. of HIV unexposed babies studied = 100. No. of HIV exposed babies infected with HIV = 1 (2%). Birth characteristics and neonatal morbidity was similar in both the HIV exposed and unexposed babies. Growth and Development was similar in HIV exposed and unexposed babies. Acute watery diarrhea and otitis media were more common in the HIV exposed when compared to HIV unexposed babies. Worm infestation and generalized lymphadenopathy were more common in the HIV exposed when compared to HIV unexposed babies. There was no difference in the mortality among HIV exposed and unexposed babies. The parent to child HIV transmission rate was 2% in our study. CONCLUSION: Thus our study has found that HIV exposed babies are not at additional risk for neonatal adverse outcomes when compared to unexposed babies. Growth, development and major congenital anomalies are not influenced by HIV exposure. Acute watery diarrhea and otitis media are more common among HIV exposed when compared to HIV unexposed babies. But these findings have to be confirmed by larger prospective studies. Wasting – pre pregnancy weight and height less than 45 kg and 145 cms respectively.