Children with AIDS -- can we afford to treat them?
A decision about the treatment of pediatric AIDS in South Africa, whether optimal or palliative care, is needed before the case load expends. As of July 1991, there were 838 AIDS cases in South Africa, and 20 cases have been seen in the Universities of Cape Town and Stellenbosch Pediatrics Departments. Treatment of pediatric AIDS is prohibitively expensive. These children have averaged 9 months of age, with an average survival time of 3 months for the 35% who have died. The 20 have accounted for 42 hospital admissions, averaging 26 days long, compared to 5 days for general patients, and costing R6500 each, compared to R750 for general patients. Drug costs average R373 per admission, compared to R31 for general patients. 2 potentially effective treatments are AZT and iv immune globulin (IVIG), costing R4880 and R7200 respectively per year per child. It is evident that optimal treatment of children with AIDS will have a severe impact on funds available for pediatric hospitalization. Arguments for minimal palliative care of pediatric AIDS cases include the scarcity of resources, poor prognosis, and poor drug compliance and follow-up. On the other hand, many children with AIDS are from minority groups, and risk being denied equitable treatment. There is a desperate need to identify subgroups of children who would benefit from aggressive care, and also to establish alternative primary and home care for more seriously affected childhood AIDS cases.