A Personal Note on World AIDS Day 2015

A Personal Note on World AIDS Day 2015 by Dr Henry Adam MD, FAAP, Associate Editor, In Brief, Pediatrics in Review Jojo was a 2-year-old boy admitted to the children's service at Mount Sinai Hospital in New York when I was the supervising resident there in 1981. He came to us with failure to thrive, hepatosplenomegaly, generalized lymphadenopathy, recurrent ear infections, pneumonias and thrush. His mother, a heroin addict dying of multiple organ failure, was at another hospital.

We were lucky to have a sophisticated immunology division that, after extensive evaluation, thought Jojo likely had Nezelof syndrome. The child died shortly after receiving a bone marrow transplant.

And I awoke in the middle of a night 3 years later screaming to myself that, of course, Jojo had been my first encounter with a child dying of AIDS.

By then I was working at Jacobi Medical Center, a municipal hospital in the Bronx, an epicenter of what had become the AIDS epidemic in the United States. Universal anonymous screening of newborns in New York State during the late 1980s showed that 2% to 5% of women delivering babies in the Bronx were HIV-infected; with a perinatal transmission rate of 25% to 35%, somewhere between 1 in 200 to 1 in 50 babies born in the Bronx in those years was infected with HIV.

Not altogether different from sub-Saharan Africa.

In 1990, at the peak of the epidemic, 2,000 women with HIV infection gave birth in New York State - meaning that in that one year alone, between 475 and 750 babies were infected perinatally.

By 1997, zidovudine (AZT) given to infected women during pregnancy and labor and to their newborns for 6 weeks after birth had been proven dramatically to reduce the rate of mother-to-child infection: in New York State, with the initiation of universal prenatal screening and AZT for women found to be infected, the transmission rate went down to 10.9%, and "only" 97 babies were born infected.

With the advent of highly active antiretroviral therapy, the transmission rate in New York was down to 2.8% by 2004, with 16 infected newborns; and by 2013 the rate was < 1% and only (without quotation marks) 2 babies were infected perinatally throughout the state.

In the past year, the State Department of Health was rightly proud to announce that for the last 12 months there had not been a single baby born infected with HIV in New York.

We have gone from an unknown, unrecognized infection to a devastating worldwide epidemic to a limited but meaningful victory in the span of one career, only 35 years. But the good news in New York is in fact limited.

Although it is true that Cuba eliminated perinatal transmission before New York did, sub-Saharan Africa is neither Cuba nor New York: in several of its countries the massive dying of their young has cut their national life expectancies fully in half.

The bad news for us at home in the US is that we still see 45,000 new HIV infections annually, a preponderance of them among adolescent and young adult men.

And of the 1.2 million people in the US who are infected with HIV (which disproportionately affects people of color), almost two-thirds are not receiving treatment - a tragedy for them, and a public health failure for the

On the one hand, certainly good news for World AIDS Day; but still so much work to be done.

In remembrance: Erica and Lamont, Jillian and Lashea, Johnny and Rayray, and too many more … .

● Pediatrics in Review on Facebook