Opportunistic infections have been identified as the leading cause of death in HIV-positive children in Sindh
aved Selro, a resident of Allah Dinho Selro village in the Ratodero area of Larkana, Sindh, knew nothing about the severity of HIV infection in April 2019 when health authorities told him that he, his wife and all three of their children were HIV positive and that they would have to take medicines regularly for their entire lives to remain healthy.
Despite getting treatment and taking medicines regularly from the HIV treatment centre in Ratodero, the condition of Javed’s children started to deteriorate within a few months. In 2020, his three-year-old son died due to co-infections, which included tuberculosis. His wife and the other two children, a daughter and a son, are also suffering from TB, hepatitis C and malnutrition.
Several health experts who visited Larkana and its Ratodero taluka where most of the HIV cases were identified in April 2019, believe that lack of routine immunisation, malnutrition, advanced stage of HIV infection as well as co-infections including TB, hepatitis B and C as well as water-borne and vector-borne diseases are killing the children in the area. The situation has deteriorated after flooding in Sindh during the last monsoon season. It is feared that more children will die in the weeks and months ahead.
According to official data available with The News on Sunday, around 324 children infected with HIV in Sindh, mostly in Larkana and its suburbs, have died so far due to complications of the disease. The April 2019 HIV outbreak in children has been the largest worldwide in recent years.
The official data available with TNS reveals that so far, 2,865 children have tested positive for HIV in Sindh, most of them in Ratodero taluka of Larkana. Some cases have also been reported in Garhi Khero, Garhi Yasin and Sujawal Junjeo talukas, which are adjacent to each other and have been known as the hub of HIV-infected children in Sindh. Of the 324 HIV-positive children who have died in the area since April 2019, 164 died during the last year, between January 2022 and February 15, 2023. Till January 2022, only 160 children infected with HIV had died in the area since the outbreak was first reported.
“324 children - 207 boys and 117 girls – had lost their lives due to complications of HIV and opportunistic infections in Sindh till February 15. These children had tested positive for HIV during the last four years, and many of them were under treatment for HIV”, said a Health Department official. The official added that of the 2,865 children infected with HIV in Sindh, 1,672 are boys while 1,193 are girls. The age of most HIV-positive children is up to 15 years, but most of the children who died due to HIV and co-infections were under ten years of age.
As HIV has spread to the general population in Ratodero and adjoining areas, people are continuously testing positive for it. In the first two months of 2023, 64 persons tested positive for HIV, including 17 children. Officials blame the reuse of syringes, infected blood and poor infection control practices for spreading HIV in the area.
Commenting on the deaths of children infected with HIV in Sindh, pediatric infectious diseases expert Dr Fatima Mir said TB was the major cause of death among children infected with HIV, adding that there were several other comorbidities or diseases that led to the deaths of these children. “First of all, most of these children were unvaccinated and malnourished. They belonged to impoverished families who don’t have enough to feed them. Most of the HIV-positive children were anaemic, which means that their hemoglobulin levels were below the normal range, which is 12-15 g/dL.” According to Dr Mir, most of the HIV-infected children were also infected with hepatitis B and C. Many of them were also suffering from other opportunistic infections.
Dr Mir, who had predicted the death of around 50 per cent of the HIV-positive children within a year or two after the Ratodero outbreak was reported in April 2019, said only 11.30 per cent of children had died due to complications of the infectious disease, which was an outstanding achievement for the officials associated with the HIV/AIDS control programme in Sindh.
Gulbahar Shaikh, a resident of Ratodero, whose six-year-old daughter is HIV positive, believes that lack of awareness among parents of HIV-infected children is the main cause of deaths of children in Larkana as people don’t take their children to the HIV treatment centre regularly. According to him, children infected with HIV not only need anti-retroviral therapy (ART) drugs regularly, they also need medicines for other infections and diseases, food and iron supplements and regular check-ups. But many parents were not consistent, and due to the virus becoming active in their bodies, the children died after contracting opportunistic infections, especially TB.
“We need pediatric infectious diseases experts as well as counsellors in the area to create awareness among parents regarding HIV. There is a need to highlight the importance of following the treatment plan and giving timely medicine to children and adults suffering from HIV. Most of the HIV-positive children died because their parents stopped their treatment, assuming that they were healthy and didn’t need any medicines,” Shaikh added.
Commenting on the situation in Ratodero and Larkana district, the newly appointed additional director of communicable disease control for HIV/ AIDS Dr Muhammad Naeem, claimed that only 218 children have died in Larkana and Ratodero, of which 113 died in Larkana while 105 children died in Ratodero taluka alone.
“There are 2,189 children infected with HIV in Larkana and Ratodero, of which 702 are in Larkana, and 1,487 are in Ratodero. 2,028 of them are on treatment at centres in Larkana and Ratodero”, he said. He said data showed that most of the deaths occurred in children who came with advanced stage of disease and died within 3-4 months of care. Advanced disease, tuberculosis and anaemia were identified as risk factors for mortality and are a programme priority in the coming year, he added.
“The programme has taken the comment attributed by Mr Gulbahar Shaikh seriously, even though it may represent a personal opinion. The CDC-HIV/ AIDS Sindh is constantly working to improve community awareness and adherence to treatment,” said Dr Naeem.
The writer is an investigative reporter, currently covering health, science, environment and water issues for The News International
“Around 324 children, including 207 boys and 117 girls, had lost their lives due to complications of HIV and opportunistic infections in Sindh till February 15. These children had tested positive for HIV during the last four years. Many of them were under treatment for HIV”.