AIDS program reports stunning success

Warren Andiman, MD and Yale’s Pediatric AIDS Care Program staff have been so effective they will likely close their doors in the next few years.

[December 2009] In the mid-1980s, when the Yale Pediatric AIDS Care Program began caring for HIV-infected children, young patients died painful and protracted deaths, often before they celebrated their 10th birthdays. “There’s no way to describe what it was like,” says Warren A. Andiman, M.D., medical director of the Yale Pediatric AIDS Care Program.

But in the ensuing 25 years, the program has been so effective in diagnosing, treating and monitoring pediatric AIDS patients that it will likely close its doors within the next few years. “We have literally been putting ourselves out of work,” says Andiman, quickly adding that this “is the crowning achievement of my career.”

Since its 1986 opening, the Pediatric AIDS Care Program has admitted every baby born to an HIV-infected mother in Greater New Haven, or about 500 babies. During the first decade, about 20 percent of those babies were infected with HIV themselves. As a result of the program’s efforts, that number dropped to zero in 1996 and has never gone up. New Haven’s protocols for preventing mother-to-child transmission have been so effective that the only HIV-positive infants delivered in the city over the past 13 years were born to mothers who had not yet been diagnosed with the disease themselves.

These encouraging developments in the fight against AIDS aren’t unique to New Haven. Today mother-to-child transmission is a rarity in the developed world. Nationwide, the rate is less than 2 percent. Andiman attributes the dramatic reduction in the number of infants born HIV-positive to “will and money.”

Any pregnant woman in New Haven who tests positive for HIV is referred to Yale’s High-Risk Maternity Program or a parallel program at the Hospital of St. Raphael. Both programs work with the Yale Pediatric AIDS Care Program to protect the fetus from contracting the virus. The mother is given antiretroviral drugs during her pregnancy and delivery. Caesarean deliveries and avoiding breastfeeding can also reduce mother-to-child transmission.
 
In addition, HIV-positive women are connected with the adult AIDS clinic. Social workers are available to help address and remediate such related practical and emotional issues as housing, drug treatment, enrollment in entitlement programs including Medicaid and the Women, Infants and Children (WIC) nutrition program, and making certain their babies have a primary care pediatrician. The women’s older children and sex partners are tested and treated, if necessary. “It’s a sort of seminal period, a moment when all kinds of worthwhile stuff can happen,” says Andiman.

When the Yale Pediatric AIDS Clinic closes, Andiman says the remaining 30 patients will be transferred to internal medicine practitioners or to the Yale Pediatric Infectious Diseases Clinic, depending on their ages. “It's reached the point where AIDS can be treated as an infectious disease just like many other infectious diseases,” he says.

Story by Colleen Shaddox