Perspective

WHO backs response to HIV outbreak in Pakistan

WHO announced today that they will be supporting the response to an outbreak of HIV that has affected more than 600 people in Larkana, Sindh province, Pakistan, with most infections occurring among children and young people.

Experts from the organization and the Global Outbreak Alert and Response Network will work with the country’s ministry of health to provide guidance regarding HIV testing, pediatric HIV treatment and family counseling. They will also confirm that enough rapid diagnostic tests and antiretroviral medications are available for both adults and children in the area, along with other supplies, including single-use needles and syringes.

The outbreak was first identified on April 25, and on April 28, an HIV screening program was implemented in the region. WHO reported that more than half of the infections were among children aged younger than 5 years. They noted that the screening program was expanded on May 8, and further testing will continue in the area.

In response to the outbreak, local authorities have developed an ART clinic for children in Larkana.

Before the outbreak began, slightly more than 1,200 children were diagnosed with HIV and received ART in the entire country. – by Katherine Bortz

WHO announced today that they will be supporting the response to an outbreak of HIV that has affected more than 600 people in Larkana, Sindh province, Pakistan, with most infections occurring among children and young people.

Experts from the organization and the Global Outbreak Alert and Response Network will work with the country’s ministry of health to provide guidance regarding HIV testing, pediatric HIV treatment and family counseling. They will also confirm that enough rapid diagnostic tests and antiretroviral medications are available for both adults and children in the area, along with other supplies, including single-use needles and syringes.

The outbreak was first identified on April 25, and on April 28, an HIV screening program was implemented in the region. WHO reported that more than half of the infections were among children aged younger than 5 years. They noted that the screening program was expanded on May 8, and further testing will continue in the area.

In response to the outbreak, local authorities have developed an ART clinic for children in Larkana.

Before the outbreak began, slightly more than 1,200 children were diagnosed with HIV and received ART in the entire country. – by Katherine Bortz

    Perspective
    Paul A. Volberding

    Paul A. Volberding

    The challenge of HIV control remains real. We have the tools to prevent transmission, but there is a real cost in deploying them, and in many regions, ongoing HIV-associated stigma and societal inattention to the epidemic remain significant barriers.

    Although the root cause of the current outbreak in Pakistan is not yet reported, we do know that HIV in very young children must be due to infection in women giving birth or in parenteral exposure to HIV-contaminated needles and/or blood products. Either source can be successfully interrupted.

    Universal testing of adolescents and adults, including women of childbearing age, should be established globally. Treatment of infected persons essentially is completely effective in preventing transmission, including to the fetus and newborns of infected women giving birth. Similarly, the blood supply can be protected by screening blood donors and referring those found to be infected into HIV care. Procedures to avoid reuse of needles and associated medical equipment are also straightforward and available, although again at a cost.

    Earlier in the epidemic, an outbreak of HIV infections occurred in China due to poor transfusion practice and, more recently, in the Central United States through needle sharing during injection drug use. Both outbreaks were contained with public health interventions. It is hoped that the origin of the newly reported outbreak in Pakistan can be swiftly determined and resources applied to contain it as well. And more importantly, we would hope future avoidable transmissions can be prevented by using the knowledge, tools and experience that we now possess.

    • Paul A. Volberding, MD
    • Professor of medicine
      Director, AIDS Research Institute
      University of California, San Francisco

    Disclosures: Volberding chairs a data management committee for a clinical trial run by Merck.