Baylor Pediatric Resident Recalls Tragedy of AIDS in Romania

Seeing untreated children in Romania losing the battle with HIV has made a Baylor College of Medicine physician more appreciative of medical care in the U.S.

"Every time I treat American children who are HIV positive, I think of how lucky they are to have access to the best medical treatment in the world," says Dr. John Vanchiere.

Dr. Vanchiere spent two weeks in Romania earlier this year to learn more about HIV in children as part of his pediatric residency training at Baylor.

"It was quite a shock," says Dr. Vanchiere, noting that more than half of all European pediatric AIDS cases occur in Romania, where more than 90 percent of AIDS cases occur in children.

"Due to a lack of medical supplies in Romania, where the economy is very poor, syringes for medical treatments were re-used in the early `90s," he says. Children there are most likely to get HIV from contaminated needles or blood.

"Most children in Romania receive either no or inadequate medications for the complications of the virus that causes AIDS," he says. "It was painful to watch the progression of HIV in children who could not be treated."

Most Romanian children with HIV die of opportunistic infections like tuberculosis in the lungs or brain, pneumocystis pneumonia, or rapid neurological decline.

"Kids come into the hospital with advanced AIDS every week because they have been abandoned by families who are unemployed and can't afford to take care of them," Dr. Vanchiere says.

During visits to infectious disease hospitals in Romania, Dr. Vanchiere witnessed the heartbreaking decisions that have to be made. With an estimated supply of anti-viral drugs available for only 20 percent of the patients, Romanian physicians have to decide whether to give 100 kids medication for a month or limit treatment to 10 kids so there will be enough drugs for a year.

"The Romanian physicians have to decide whether to treat the sickest patients in hope they will do better, or treat the patients who are most likely to survive longer," Dr. Vanchiere says.

Because of the funding available for medical care in the United States, doctors treating children with HIV here don't have to ration medications, Dr. Vanchiere says. "HIV will come back with a vengeance if you stop giving the patient medication."

He often saw coffins strapped to the tops of cars in Romanian cities like Constanta, where more than 1,000 kids have AIDS and the death rate is 16 percent per year.

Dr. Vanchiere conducted physical exams in hundreds of children and provided treatment for such acute symptoms as stomach pain and fever. His visit, arranged by the Baylor International Pediatric AIDS Initiative, enabled him to observe a variety of symptoms that HIV can cause if the disease is not treated.

"The kids I saw were very appreciative of the care we provided," Dr. Vanchiere says. "They gave hugs, said `thank you,' and showed excitement and joy. I wanted to bring so many of them home with me."

Now a fellow in infectious diseases at Baylor, Dr. Vanchiere says his experience in Romania had quite an impact. "I learned first hand that there are children in great, great need that we could never imagine," he says.

"The trip made me appreciate how blessed we are in this country." The trip also inspired Dr. Vanchiere to set up a two-year study of whether large doses of vitamin A can reduce complications in Romanian patients with HIV. When he returns to Romania in April as part of his fellowship training, he will take a supply of vitamin A donated by Pharmavite in California. Preliminary results from a similar study in Africa look promising, he says.

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©2006 Texas Medical Center

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