The changing epidemic of pediatric hiv infection in romania

PURPOSE: By the late 1980s, over 100,000 infants and children were living in public institutions in Romania. It was not uncommon for children in these facilities to receive one or more 'micro-transfusions' of blood, unscreened for HIV, as therapy for anemia or malnutrition. To assess the impact of pediatric HIV infection in Romania, the European country with the most pediatric cases, cross-sectional and cohort studies were implemented in Constanta (the epi-center of pediatric HIV in Romania) in April 1999.METHODS: Demographic, clinical and social data are collected once for all cross-sectional subjects. Similar data are collected every 11-13 months for subjects in the cohort. The cross-sectional study population was defined as all living HIV-infected infants and children, 0-18 years, known to the investigators from April to September 1999. The cohort consists of subjects diagnosed with HIV between 1995 and 1999.RESULTS: Enrolled are 791 subjects, of which 357 are in the cohort study. The majority (83%) are Romanian, vs Gypsy or Turkish/Hun and their mean age is 11 years (SD = 1.3). Biologic parents are the primary caretakers of 77% and 86% attend school. Mode of transmission was perinatal for 8%; blood transfusion/parental therapy modes account for 89% of the transmission and the presumed timing was between 1-12 months of age. Mean age at HIV confirmation was 5 years (SD = 3.2). AIDS has been diagnosed in 40% and 52% are receiving antiretroviral therapy.CONCLUSIONS: The Romanian pediatric HIV epidemic differs vastly from that in the US. Fewer children are with their biologic parent(s) and attending school. Early diagnosis of infection is rare, as therapy did not become available until the late 1990's. Perinatal transmission is increasing, however, which supports the need for HIV education and intervention in Eastern Europe.