Backlog on moms, kids, and HIV...and my lost chance at Indian TV stardom

This is an extra post from yesterday, but there was a lot of technical knowledge that we gained from Dr. Gupta (despite our non-medical status…perhaps he was humoring our curiosity). We talked about the prevention of mother to child transmission (MTCT), which was the most interesting to me (maybe because in my head it seemed the most controversial) as well as the picture of tuberculosis (TB) in India.

MTCT is more common in India than it is in the U.S., but unlike what most people might think, it’s not as though an HIV-positive mother will definitely transmit the virus to her child. In fact, given no precautions, the risk of MTCT in poorer countries is about 33%, while in more developed countries it’s 20-25%. Why the discrepancy? Because the period during which the baby is at risk for getting HIV is not during pregnancy, it’s in the birthing process. That’s the only time that the mother’s blood can come into contact with the baby’s—particularly if there are vaginal cuts, or if the health professional’s instruments cut the baby while delivering it.

Why the controversy? To me, it’s controversial because while there are ways to guard against MTCT, those ways seem to be potentially harmful to the HIV-positive mother. They have implications for her disease management after birth. Yes, the baby’s ok, and that’s what’s important (any mother would agree). But what about the mom? What are the implications of taking short-term ARVs which would in some cases otherwise not be prescribed? The mother takes them for a short while, which puts her at a great risk of ARV resistance later on. At some point, if not now (if her CD4 count right now is high, above 200), she will need ARVs to prolong her life. But they may not work for her because she took a short course during pregnancy and breastfeeding. In India, this situation is more significant because of the fact that there are much fewer ARVs to choose from…knock one or two out due to resistance, and your choices are disturbingly fewer. If the mother’s life is significantly shortened, it takes a little bit of joy away from the child’s seronegativity.

At the end of the day, you really see how limited we are in treating these diseases and their complications, from a pharmaceutical perspective. Even as a clinician seeing patients suffering day in and day out, and scraping pennies to get care for those in dire need, Dr. Gupta admits that the billions of dollars going into finding a far-off HIV vaccine are justified. It will be at least 10-15 years into the future, but just think of how much suffering it would avoid. Seeing those two leprosy patients yesterday, and how there is now hope for them to take a 5-6 month course of drugs and be cured from this horrible, disfiguring disease, it made me so grateful for whatever drug company it is (if I had more time to look it up, I would) that figured out how to make this disease a curable ailment, and how to shorten the treatment from 5-6 YEARS to the same number of months.

And finally, I forgot to mention in my blog for today that this evening, during our little hangout session, I had the opportunity to get on stage in a little shopping plaza in front of lots of oglers, and sing a tune on some sort of singing show a la American Idol (key words: a la). But I backed out, and I'm afraid Sej may never forgive me. In fact, I might never forgive myself, either. Emma also lost out on an opportunity at fame--she was asked to comment on one of the contestant's performance, and backed out (she ducked behind me, the freakishly tall girl). Sej stepped in, as always, ready to give her opinion...although her "he did good" didn't really reflect well on American grammar in general. Thankfully, they didn't know we were grad students (minus Paul, future doctor of America...which is just as bad).