Ryan White grantees and providers rapidly implemented prevention of MTCT while caring for HIV-positive women and their families. As a result, MTCT rates in the United States have been slashed from an all-time high of 1,650 cases in 1991 to an estimated 130 cases in 2009.2,3 At New York’s Bronx-Lebanon Hospital Center, “We still deliver about 50 babies each year to HIV infected women,” says Telzak. “By having a talented nurse midwife and high-risk obstetrician on site, only one baby born in the last 3 years was infected.”
Thanks to the tireless work of Ryan White grantees and providers, many perinatally infected children have grown into adulthood. As of 2005, 6,051 perinatally infected people were living in the United States.4
“Kids who were perinatally infected in the 1980s and early 1990s have grown up to be adolescents and young adults, because they have gotten good HIV care at Ryan White clinics,” says Schwartz. “But they have had chronic HIV infection for 20 years or more; their issues are very different from people who were infected in their 20s and 30s and are now in their 50s and 60s, or the adolescents who get HIV as teens.”
The Ryan White HIV/AIDS Program's Part D Program is dedicated to serving the needs, and striving to create a healthier future for women, infants, children, youth, and their families.
Although ART works for children, the long-term consequences of its use at an early age are unknown, and short-term complications of ART have been reported. Researchers have identified an increased cardiovascular disease risk profile among HIV-positive children and adolescents on ART.5,6 Children have developed ART-associated metabolic abnormalities, such as lipodystrophy (abnormal fat distribution), lipoatrophy (localized fat loss), insulin resistance, and hyperlipidemia.7,8,9 The risk for bone loss is higher for HIV-infected children and adolescents; when peak bone mass is achieved, bone cell turnover is higher in childhood than adulthood. Low bone mineral density (BMD) and low bone mineral content (BMC) have been reported in perinatally infected children—especially boys.10,11,12,13 Vitamin D deficiency, which is common among perinatally infected children, is associated with low BMD and BMC; it is caused by ART and HIV itself.14,15
Caring for perinatally infected adolescents can be challenging and requires the wraparound services that Ryan White HIV/AIDS Program provides. Developmental, behavioral, and psychiatric disorders are more prevalent among perinatally exposed and infected adolescents than their nonexposed, noninfected peers; these disorders worsen adherence to ART, particularly in adolescents.16,17,18,19,20,21