Six weeks ago, the mother of a five month-old baby girl noticed that her daughter was breathing rapidly. She had never been to the pediatrician before — somehow, the mother had managed to avoid all of the regular infant visits — but she knew that there was something wrong with her daughter’s health, and felt that a doctor’s visit was in order. The pediatrician took one listen to the baby girl’s heart and also knew that there was something wrong; after being shipped to the local hospital for an echocardiogram, the heart specialists confirmed that the baby’s rapid breathing was a consequence of a congenital heart condition that had slowly caused fluid to back up in her lungs, and they arranged for her to be transported to our hospital for emergent surgery. On the morning of the surgery, the infant was found to have a severe viral infection of her lungs, one which had a significant impact on the chances of her surviving the operation. Her surgery was postponed, and she returned to the intensive care unit to await the time when her lungs would be ready.

During the time that she was waiting, a tube of the infant’s routine bloodwork was dropped in the laboratory, splashing in a lab tech’s eyes. This event triggered a routine hospital response; whenever an employee is directly exposed to blood, steps are taken to help determine the need for treating with medications to help prevent the spread of HIV and other communicable diseases. Among other things, routine consent was obtained from the parents to run HIV antibody tests on the infant’s blood, and most everyone (except the lab tech) promptly forgot that the precautionary tests had even been sent. Thus, nobody was prepared for the phone call that we received three days later: the tests were positive.

Immunologically, five month-olds live in two worlds — their own immune systems are up and running, but they also still have their mothers’ antibodies floating around, helping to fight against infection. Because of this, further tests had to be run to determine if we were seeing the signs of a maternal infection or a pediatric one. In addition to a few confirmatory tests on the infant, blood was sent on both parents, hunting for the source of the antibodies that we were seeing on the positive tests. All of the further testing on the infant has, thus far, come back negative; both of her parents, however, have proven to be HIV-positive. In the flash of a single broken test tube, a family learned that both parents are infected with the virus that causes AIDS, and that their daughter is still not out from under its shadow. Upon further questioning, we learned a piece of information which completed the depressing epidemiologic tree: the father was infected by HIV while in prison, the mother was infected by the father, and the baby was exposed while in utero. Three lives have been placed in jeopardy by a single deadly virus.

Today, both parents have a good chance of living to see their daughter grow up, thanks to advances in HIV and AIDS therapy which have extended the life spans of those infected by decades, if not longer. The emotional toll that the virus takes on children and their families is not as easily addressed, though. Fortunately, organizations like the Elizabeth Glaser Pediatric AIDS Foundation and the Children Affected by AIDS Foundation focus on enhancing the lives of children and families with AIDS, and better medical information up front helps people more clearly understand how to avoid contracting HIV. Only through this two-pronged approach — better medical research and wider social acceptance — will we tame this modern beast.

link and think / world AIDS day 2002