Dec. 20--Being born HIV-positive used to be a death sentence.
In the 1980s and early '90s, some babies would die before their first birthdays, while the vast majority succumbed before age 10.
"Most of the kids weren't expected to make it to school age, much less junior high," said Dr. Tess Barton, medical director of the AIDS-related medical clinic at Children's Medical Center Dallas.
Now the median survival for children infected at birth with HIV is age 18, although it keeps going upward as they continue to stay healthy and grow older.
"The oldest one in Dallas is 26," Barton said. "And a 25-year-old woman who was born with HIV gave birth to a child recently who was HIV-negative."
The world of HIV-infected children has changed radically along with that of adults infected with the human immunodeficiency virus. Both groups have benefited from the development of an array of antiretroviral drugs since the mid 1990s. Such drugs can keep the virus at bay for years or even decades, allowing patients to have a full life.
"They're growing up and becoming adults, going to college, getting married and having babies of their own," Barton said. "I don't think we know for sure how long they're going to survive."
Her clinic monitors 110 HIV-positive patients, ages 7 months to 22 years. As they age, they are transferred to doctors who specialize in adult care of HIV/AIDS.
What's keeping HIV carriers healthy is a menu of nearly 30 drugs, mixed in "cocktails" of three or more at a time, which can fend off the virus. When a certain combination no longer works, it can be substituted for another and another.
"It's possible there may be no progression to AIDS, if you're taking the medication and not developing resistance to them," said Dr. Kenneth Dominguez, an expert on pediatric HIV and AIDS at the Centers for Disease Control and Prevention.
"HIV is now a chronic disease," he said. "But the patients have to stay on the medicine for life and go to the doctor every three or four months."
By 2007, the CDC was tracking slightly more than 8,000 children who were HIV-infected at birth in 37 states and five territories. An additional 4,489 children were known to have died of AIDS complications since the epidemic began.
Children hit risky territory when they go through adolescence and possibly lose interest in managing their health.
"Sometimes, they assert their independence and decide not to take any more medication," Dominguez said. "If they do that, they can revert to developing AIDS-defining conditions, and they can die."
There is little room for leeway in taking these drugs. For the medication to work, it requires 95 percent adherence to the pill-taking schedule, he added.
But the number of children born with HIV has tapered off dramatically since the early '90s. Pregnant women now known to be HIV-positive are routinely given drugs to protect their babies from being infected.
"When infected mothers take medication, only 1 to 2 percent of their babies get HIV," said Barton, also an assistant professor of pediatrics at UT Southwestern Medical Center. "Without the medication, 26 percent of the babies were born with it."
If HIV infections were eradicated at birth, it would put an end to pediatric HIV and AIDS as a medical specialty, she noted.
"And I'd be happy to be out of a job."
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