April 7, 2011

Early Days Of AIDS Clinic In Romania Set Stage For BIPAI

It is less than a week until the 10-year anniversary celebration of the Baylor International Pediatric AIDS Initiative at Texas Children's Hospital's first pediatric HIV/AIDS clinical center abroad. Founder Dr. Mark Kline has a packed Friday "“ not unusual considering he also serves as both the chair of pediatrics at Baylor College of Medicine and physician-in-chief of Texas Children's Hospital. The office is even busier as he prepares to travel to Romania for the celebration.

Despite the hectic pace, there are no distractions "“ only delight, enthusiasm and excitement - when he reflects on the 430 HIV-infected children he helped bring back to life in the months following the April 6, 2001, opening of the clinic in Constanta, Romania. The success of the clinic helped shape the expansive BIPAI clinical network that now blankets south east Africa, and has treated more than 80,000 children.

Success in treatment of American children

In the early 90s, Kline was one of the pioneers of anti-retroviral treatment for American children with HIV/AIDS.

"We were among the first to use these drug cocktails for American children. Our pilot study of highly-active antiretroviral therapy in 12 children at Texas Children's Hospital helped establish that the drugs could be used safely and effectively. The children we enrolled had very advanced disease; some were in hospice care," said Kline. "These drugs brought them back to life."

It was the first time that treatment had made a lasting difference in HIV- infected children. "The treatments had a profound impact on restoring the immune system and preventing complications," said Kline.

Concerns over benefits in treating children of developing world

Though the HIV/AIDS epidemic peaked in the mid-90s in the United States, the developing world was far behind. Kline believed children in the developing world could benefit from anti-retroviral therapy the same way American children could.

"There were many medical authorities that said this could not be done, that it was irresponsible at best, and maybe impossible," said Kline. "There were concerns that these children would not tolerate the medications as well as American children and many would die."

Romanian clinic gets its start

With help from the Abbott Fund and the Sisters of Charity of the Incarnate Word, Kline and the BIPAI team opened the Romanian-American Children's Center in Constanta on April 6, 2001.

Very soon after the clinic opened, work began to initiate a program of highly-active antiretroviral therapy. Over a period of about six months, about 430 HIV-infected children began treatment. At the time, this was the largest number of children treated for HIV/AIDS in any single center worldwide.

"These were some of the sickest children I had ever seen in my life," said Kline. "They were hanging on by a thread and in terrible shape."

Kline, a Baylor faculty member and leading Texas Children's infectious diseases specialist at the time, spent the ensuing months carefully monitoring and evaluating each child's medical condition. His team in those first days included Nancy Kline (a pediatric nurse practitioner), Nancy Calles (a registered nurse, now BIPAI's senior vice president for international program development) and Cara Simon (a registered nurse now working in the Texas Children's Cancer Center).

"We took the concerns about toxicity very seriously. We monitored very closely how these children tolerated the medications," said Kline. "I was scared to death that they would get sick or die."

But the exact opposite happened.

Miraculous recoveries

Within one or two months of beginning treatment, many of the children had gained weight (2 to 4 pounds in some cases), skin and mouth sores had healed and their hair became fuller. "They were growing taller and taller, it was just remarkable "“ child after child, day after day."

The growth and healing would continue progressively over the following months. There were no longer concerns about toxicity and weekly visits became just monthly.

"Before you knew it, these kids, the ones you could spot as being in terrible shape from across the room, were up and running around, happy and healthy," said Kline, who speaks of observing this healing as an 'addictive' experience. "Many kids had been out of school during their illness and now they were able to go back."

Another fond memory for Kline is the reaction from the children's mothers. "I would always ask the mothers if they had any complaints or problems. I remember one mom saying 'my only complaint is that my son is now eating us out of house and home.'"

Model for care in the developing world

Kline and BIPAI's efforts to expand access to HIV/AIDS care and treatment in the developing world would no longer be met with issues of concern, following the success in Romania.

In 2003, a BIPAI children's center in Botswana would follow and continue with the same remarkable experience. About 1,400 children began treatment in that center the year it opened. "This was the largest number of children in treatment for HIV/AIDS anywhere in Africa."

Growth in ten years

In the last 10 years, using the success of the Romanian clinic, BIPAI has been able to expand its network of children's centers to include clinics in Uganda, Tanzania, Malawi, Swaziland and Lesotho, some of Africa's hardest hit regions for HIV/AIDS.

Although Kline has risen in the ranks at BCM and Texas Children's (he assumed the role of chair of pediatrics at BCM and physician-in-chief of Texas Children's in July 2009), his passion and dedication to improving global child health remains strong.

"If it was just about me and no one else, I would park myself in a clinic in Romania and see patients all day long," said Kline. "But now, I think I have the opportunity to have a bigger impact, to help build programs and secure resources and support for other, valuable initiatives."

On March 23, under Kline's leadership, BCM and Texas Children's announced the Texas Children's Center for Global Health. A key initiative of that center is a new sickle cell disease screening program in Luanda, Angola. The program will be led by renowned clinician-scientist Dr. Russell E. Ware, who Kline helped to recruit.


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