One sneaky virus

The recent Joint United Nations Programme on HIV/AIDS report states that “in 2023, 6.7 million people living with HIV were residing in Asia and the Pacific, … [accounting] for a quarter of annual new HIV infections globally … Among countries with available data, HIV epidemics are growing in Afghanistan, Bangladesh, Fiji, the Lao People’s Democratic Republic, Papua New Guinea, and the Philippines.”

According to the website of the Philippine News Agency, the Department of Health from January to March of this year, recorded a total of 3,410 new cases and 82 reported deaths. While these numbers are concerning, it is particularly alarming that the majority of new cases occurred in the 15-24 age group.

As physicians, we have been trained to spot red flags that warrant screening and testing which are vital for early intervention and management. From the cases we have seen in the pediatric age group, the possibility is entertained on the background of a history of unexplained fever, rapid weight loss, intense fatigue, chronic diarrhea, swollen lymph nodes, organomegaly, sexually transmitted infections, findings of tuberculosis, persistent oral thrush or diaper dermatitis, occurrence of serious bacterial and opportunistic infections which may include fungal or viral causes, and in some instances nonresponse to antibiotic regimens.

Let me emphasize that an infected individual can remain asymptomatic and may not be aware of their condition until years later when they present with full-blown AIDS. In such cases, getting tested is the only way to know for certain.

This reality was highlighted recently when we encountered a 2-year-old patient who came in with fever and seizures.

The child had been admitted two weeks earlier in another institution was treated for pneumonia, and subsequently discharged in an improved condition. The teenage mother subsequently reported however that the fever recurred four days later, and the child’s cough seemingly had not resolved. She mentioned that the child had never been sick until the previous month.

During the physical examination, the child’s growth and development were found to be appropriate for its age. A significant and recurrent finding in the subsequent workup was persistent anemia and low platelet count. The fellow in charge was in a quandary. What was the reason behind the depressed numbers? All the services had already given their respective inputs. Determined, she decided to be more relentless in her questioning. Eventually the mother disclosed that she had never been tested for hepatitis B, syphilis, or HIV during her prenatal checkups at a local health center. She also admitted to having multiple sexual partners and her sexual debut came early. Testing ultimately yielded positive results for both the mother and the child. Antiretroviral therapy was immediately instituted.

This case made us all, regardless of age or experience, consider that there were likely others who were infected, and we might sadly be overlooking them. On a personal note, I had to reexamine how much have we, as physicians, contributed to addressing the epidemic beyond diagnosing and administering treatment.

There is no doubt for the need to further educate the public, especially the youth, who are the most affected age group. While the school may be the most logical place to reach them, we have to remember that the home is the best place to nurture relationships, with parents as the child’s first teachers and providers of a safe and secure environment. Within the family unit, basic values are shared, the sense of right and wrong is inculcated, the importance of religion and faith instilled, which all serve as basic building blocks for a solid foundation upon which an individual’s character is formed.

How to educate is a challenge in itself, for despite the trend toward a society that has become more permissive, engaging or launching conversations on sexual health is still considered taboo and immoral. How many are actually comfortable discussing about HIV and AIDS with their children? Parents, teachers even physicians ought to hone their skills in proper age-appropriate communication that would encourage a free-flowing mutually respectful discussion between you and your child. School programs should ensure that health and sexual education are well integrated into the curriculum so that students would not only be more informed, but be more comfortable and open in discussing what may be viewed as a sensitive topic. Moreover, they should know where to seek help.

While there is no cure for this chronic condition, there is the possibility of control and the assurance that one can have a life. What used to be a death sentence is no longer.

Dec. 1 is World AIDS Day, take time to stop and think about how we can all contribute.

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