The AIDS Beacon™

Dr. Maria Patterson is a leading researcher and physician who treats pediatric AIDS patients and has seen tremendous progress in AIDS research and treatment since the beginning of the epidemic.

She received her Ph.D. in virology from Northwestern University in 1970 and attained her medical degree from Michigan State University in 1984. She currently works at Sparrow Hospital in Lansing, Michigan and is also a faculty member of the Department of Pediatrics and Human Development at Michigan State University.

In 2008, Patterson was recognized at Michigan’s 14th Annual STD & HIV Conference and was given the lifetime achievement award for her work with the disease.

Like many physicians, Dr. Patterson has an immense amount of knowledge in her area of expertise. However, what makes her unique is her sense of care and compassion.

She has seen stories of success and sorrow, and each patient that has died has a special place in her heart. She has always made it a point to attend the funerals of her patients who died.

“It is always very rewarding, even though it is sad,” she said. “You always get something from the kids themselves and their parents. For years after, I will call parents on a particular day that I think is important to them.”

Thankfully, treatment of AIDS is progressing, and HIV-positive children are living longer. More of Dr. Patterson’s patients are becoming success stories.

When she began practicing medicine in the mid 1980s, Patterson said that physicians were aware of adult AIDS. However, the presence of AIDS in pediatrics was not understood. The ability to diagnose and treat pediatric AIDS has progressed tremendously.

Early in her career, she saw many HIV-positive children and teenagers die from the disease or a secondary complication.

“Ninety percent of HIV-positive children did not live to five years old. Nearly 50 percent would not even live to be a year old,” Patterson said.

However, her last patient who died passed away in 1999. This is a good indicator of the advancements that have occurred in the last 10 years.

With advancements in antiretroviral therapy, Patterson said it is rare for an HIV-positive child not to live past their first birthday. If children are adherent to their medication throughout the rest of their lives, it is quite likely they will have a normal lifespan.

Patterson’s patients range from pregnant mothers, to toddlers, to teenagers. She discussed the different needs that each of her patients face as they progress into young adults.

Before a child is born, many actions need to be taken to ensure the virus is not transmitted from mother to child.

“Without any medical intervention, there is about a 25 percent chance of transmitting the virus during childbirth,” Patterson said.

“To prevent transmission to the infant, the mother is given zidovudine (Retrovir) during pregnancy, intravenous zidovudine during delivery, and the baby is given zidovudine by mouth for several months after birth.”

This technique became widespread after positive results were obtained from a clinical trial conducted in 1994. With further advancements, the transmission rate is only one to two percent today. Depending on the health and viral loads of the mother, additional treatments may be used. Delivering the baby by cesarean section is also used to reduce the risk of transmission.

The last child that Patterson saw born HIV-positive was in 2005 to a mother who was a drug user. Before this, the last child she saw born with HIV was in 1997. However, Patterson said that in her community, 4 out of 1,000 live births are to moms who are HIV-positive.

In most cases, by four months of age, it can be determined if a child born to a mother with HIV has contracted the virus.

“If this test is negative at four months, I suggest the infant obtain one final test at 18 months to be certain,” Patterson said.

If it is determined that the child does not have HIV, Patterson advises mothers that breastfeeding must be avoided to ensure the virus is not transmitted by this medium.

For some of her patients, the importance of adhering to this is not fully conveyed. One patient of hers, who lived in Africa, said there was no way she could not breastfeed her child because of the stigma that AIDS carries in this region; not breastfeeding is an indicator that the mother is HIV-positive.

Patterson realizes that there is much progress to be made in developing countries to prevent the spread of AIDS and increase the longevity of those infected.

“I think we are definitely winning the battle in the western world. To win it in the developing world, it is so much harder,” she said.

Every year in the United States, less than 200 children are born HIV-positive.

If a child is found to be HIV-positive, they should begin treatment immediately and expect to see a doctor every three months for check-ups.

Medication is taken twice daily and is usually a combination of three or more antiretroviral drugs. Patterson said children often do not experience as many bad side-effects as adults do on these medications.

“Children tend to handle [medications] much easier [than adults]. Early on, moms would not want to start their children on these medications and would say ‘I don’t want my child to have these problems from it that I have experienced,’” Patterson said.

At the beginning of the epidemic, often times children born with HIV/AIDS would face severe developmental problems, including difficulties with speech, movement, coordination, and balance. This can occur because the virus may affect the brain.

“Since 1997, we don’t see [developmental delays] anymore. Even before this, we knew that with pediatrics we wanted the medication to reach the central nervous system. If you began treating you always began with two drugs, one of these would go through the blood-brain barrier,” she said.

While Patterson acknowledges that it can be challenging living with HIV, she believes a relativity normal life can be led.

Although Patterson must report a child’s HIV status to the health department, she said it is not required to disclose this information to day cares or schools.

“You don’t have to worry about their feces, saliva, and tears transmitting the virus [only contact with blood]. However, I usually like to say, ‘When you begin elementary school, choose one person, whether it is a principal, a school nurse, or a favorite teacher. Inform them of the child’s medical status. Someone at school should know just for safety reasons,’” she said.

However, the most important point that Patterson stressed in order to live a relatively normal life is to be adherent to medications.

A challenge that Patterson has faced is treating many teenagers who are going through a phase of “invincibility.” When patients are children, they usually will strictly adhere to their medication regimen. However, once the teenage years begin, patients often forget how important it is to adhere 100 percent to treatment.

However, with strict adherence to medications, many of her teenage patients have thrived with controlling their disease and achieving academic and social success. One of her patients was a member of his varsity football team.

“I don’t know if we can say that HIV is like any other chronic illness. It is not exactly. You really have to be careful to adhere to your medications,” she said.

Currently, Dr. Patterson is involved in treating eight patients with AIDS, as well as other HIV-positive children who have been adopted from other countries. Patterson no longer practices full time in her clinic, but currently splits her time treating patients and teaching residents. She is also working to teach obstetricians the importance of testing for HIV in pregnant women.

Patterson is hopeful for the future. She believes new classes of drugs will be developed as researchers reexamine parts of the life cycle of the virus. These drugs may have less toxicity, may be administered once daily as a pill, or someday even once weekly.

She believes that eventually a vaccine, and maybe even a cure, will be found.