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Moyamoya disease has been reported in both children and adults with HIV-1. Most cases reported in children were found to have unsuppressed viral loads and low CD4 counts. Although the aetiology of the disease is largely unknown, a few studies have postulated cytokine imbalance and immune activation as possible causes. Intimal staining of the involved cerebral arteries have revealed transmembrane glycoprotein of HIV-gp 41. We present the case of an 18-year-old boy with congenitally acquired HIV-1 who presented with right hemiparesis at the age of 12 years and was found to have Moyamoya disease on neuroimaging. His CD4 count has always been low (<100 cells/cumm) in spite of being virally suppressed. He was started on anti-retroviral therapy at 5 and half years of age and he was continued on the same. He was treated conservatively and he continues to have residual right hemiparesis. [ABSTRACT FROM AUTHOR]

This presentation focuses on the challenges and practical issues faced each day by orphans of the HIV epidemic and the holistic care that can be provided, as they continue to grow from toddlerhood to adolescence and beyond. An HIV Research Trust Scholarship enabled me to spend quality time in a sub-Saharan African province worst hit by the HIV epidemic and to interact with local experts and learn from mutual clinical experience. It was an immensely useful exercise as the clinical spectra of the diseases are very similar to ours and they have ongoing active research programs very relevant to our setting. India is arguably home to the largest number of orphans of the HIV epidemic. The responsibility of caring for orphaned children overwhelms and pushes many extended families beyond their ability to cope. Many countries are experiencing large increases in the number of families headed by women and grandparents, or even young children. These households are often unable to meet basic needs, and so the number of children living on the streets is rising. Orphaned children are disadvantaged in many devastating ways. In addition to the trauma of witnessing the sickness and death of one or both parents and perhaps siblings, they lack the necessary parental guidance through crucial life-stages of identity formation and transition into adulthood. They are more likely to suffer damage to their cognitive and emotional development and be subjected to; exploitation in terms of labour, social exclusion, extreme economic uncertainty, physical and sexual abuse, illiteracy, malnutrition and illness. Education remains a distant dream. With stigma and discrimination, they lack legal protection, lose inheritance rights, access to essential services available to other community members and professional help from doctors, teachers and lawyers. The implications for these unfortunate children are extraordinarily grave but governments, international agencies, non-governmental organizations, schools, other community groups and individuals can still alter the course of the crisis. The Committed Communities Development Trust (CCDT) is a voluntary secular Trust, reaching out to 300,000 people annually, focusing intensively on children affected and infected by HIV/AIDS, mainly orphans, child headed families, children living in street situations, brothels, institutions and children at risk of drug addiction, abuse and exploitation in Mumbai. We run several comprehensive HIV/AIDS programmes addressing issues of prevention, care, support, education, awareness, empowerment, training and research through strongly structured home-based care programs, community based programs and temporary residential shelters. The CCDT recognizes and understands the daunting challenges these children face and helps them overcome these as a team by providing comprehensive care and support, giving them an opportunity in life and enabling them to become productive citizens of tomorrow. [ABSTRACT FROM AUTHOR]

Background: India has recently introduced telemedicine initiatives to enhance access to specialized care at a low cost for the pediatric HIV patients, who face multiple challenges due to growing disease burden and limited preparedness of the health system to address it. There are limited evidences on the cost-effectiveness of these interventions. This study was undertaken in Maharashtra, a province, located in the western region of the country, to inform policy regarding the effectiveness of this programme. The objective was to estimate the unit cost of ART services for pediatric HIV patients and examine the efficiency in the use of resource and treatment compliance resulting from telemedicine initiatives in pediatric HIV compared to usual ART services. Methods: We selected 6 ART centers (3 from linked centers linked to Pediatric HIV Centre of Excellence (PCoE) and 3 from non-linked centers) randomly from three high, middle and low ART centers, categorized on the basis of case load in each arm. A bottom up costing methodology was adopted to understand the unit cost of services. Loss to follow up and timeliness of the visits were compared between the two arms and were linked to the cost. Results: The average cost per-visit was INR 1803 in the linked centers and that for the non-linked centers was INR 3412. There has been 5 percentage point improvement in lost to follow-up in the linked centers compared to non-linked centers against a back-drop of a reduction in per-pediatric patient cost of INR 557. The linkage has resulted in increase in timeliness of the visits in linked centers compared to non-linked centers. Discussion and conclusion: The telemedicine linkage led to an increase in the case load leading to a decrease in cost. The evidence on efficiency in the use of resource and improvement in treatment compliance as suggested by this study could be used to scale up this initiative. [ABSTRACT FROM AUTHOR]