"The first thing would-be parents ask me about is transmission," notes Linda Walsh, a family nurse-practitioner and director of clinical operations and outreach for the University of Chicago's Pediatric and Adolescent HIV team. "People come to me and say, 'HIV adoption sounds like a wonderful idea and a beautiful thought, but tell me the reality for my family.'?"
The reality is, there are only a few ways HIV can be transmitted: through unprotected sex, sharing needles or other blood-to-blood activities, breastfeeding, and from the mother to the child during pregnancy or childbirth. Sachi and her parents can—and do—share utensils, swap kisses, bathe together. Sachi can grow up and ride bicycles, play soccer with other kids, share a bathroom with girlfriends, all without fear of passing on the disease. (There is a tiny risk—1 in 4 million—of transmitting HIV through sports-related or other injuries, but there have been no known cases to date.)
The day after arriving home, an anemic Sachi was admitted to the University of Chicago Comer Children's Hospital for ten days of blood tests and treatment for dehydration and a bad ear infection, which may have resulted in partial hearing loss. Since then, Walsh and her team have had the privilege of watching Sachi transform from a slumping, malnourished infant to a bubbly, giggling little girl. When she arrived, her viral load—a measure of how many "pieces" or copies of the HIV virus are in the blood—was over 300,000 copies/mL. (Patients with a viral load of 100,000 are at risk of the disease progressing to AIDS and need treatment, according to U.S. Department of Health and Human Services guidelines.) Thanks to her medication regimen, after six months of treatment, that viral load was undetectable. ("Undetectable" doesn't mean one's HIV is cured, but that it's below machine-measurable levels.) Sachi weighed in at 12 pounds on her first birthday, and nearly doubled that weight over the next year.
Today Sachi's care involves hospital visits every eight weeks, which will eventually decrease to every three months. She undergoes a physical exam, has her viral load monitored along with her CD4 levels (a marker of how the immune system is functioning—unlike viral load, the higher one's CD4 count, the better), and has her liver and kidney functioning checked to ensure the drugs are not damaging her organs. "With proper treatment, these children can live a pretty normal existence. It's manageable," emphasizes Walsh, who has watched kids in her program grow up and go off to college.