Lessons from America

By Alice Park

In the U.S., the number of babies infected with HIV at birth has dropped dramatically--from its peak of more than 1,600 in 1991 to fewer than 50 in 2004--thanks to AZT regimens for HIV-positive mothers. But that leaves nearly 10,000 U.S. children who have been diagnosed with AIDS, and their long-term prognosis says a lot about what lies ahead for millions of children in the developing world.

Alisha Saleem, 20, was born too early to benefit from the newest antiretroviral (ARV) drugs. In fact, there weren't any HIV treatments for adults, much less children, in 1986. Saleem, who contracted the virus from her mother, an intravenous-drug user, was 4 when she took her first AIDS drug, and even then the only option she had was AZT. Today doctors know that the best way to fight the virus is to hit it with three drugs at once, one of which is preferably a protease inhibitor. But early patients like Saleem had to learn the hard way. As her virus became resistant to one drug after another, Saleem cycled through a pharmacy of options. As a result, her virus is harder to control, and she finds herself in a hospital at least once a year battling side effects that range from kidney stones to inflammation of her heart tissue. "My [immune cell] counts aren't the best," she says, "but they are stable."

Tearra Daniels, 13, was luckier. Like Saleem, she was infected at birth by her mother, a crack addict who was later murdered. Placed with foster parents the day after she was born, Daniels was 3 when she became one of the first 70 children in the U.S. to test a protease inhibitor. Even in the brief span of her lifetime, Daniels has watched pediatric-AIDS treatments improve significantly. When she was an infant, her adoptive mother Maryann had to wake her up at 4 a.m. to administer the first of four daily doses. Today the blond, blue-eyed girl, who looks like any active Midwestern teenager, has to take her medications only once a day. "Most of the time, I don't even realize I have HIV," she says.

And doctors are hoping it stays that way. But ARVs are powerful drugs, and scientists are still learning what taking them for decades does to developing minds and bodies. Dr. Rohan Hazra at the National Institutes of Health has been following patients like Daniels since their birth. He is on the lookout for behavioral changes that could be the legacy of drug effects on the central nervous system. "We are beginning to see subtle but profound impacts on the brain," he says. "Among teenagers infected [at birth], there seem to be high rates of ADHD, psychiatric disorders and cognitive problems."

As the number of HIV-positive American kids dwindles, it's getting harder to study the long-term effects of these drugs on children in the U.S. Says Hazra: "These are questions that will only be answered now in the developing world," where newly infected babies are still available, unfortunately, in huge numbers. But with the answers they provide, perhaps that current wave of young patients can be the last.