Adolescents living with HIV

Adolescents living with HIV

Undiagnosed HIV Infection among Adolescents Seeking Primary Health Care in Zimbabwe.

Mother-to-child transmission of human immunodeficiency virus (HIV) infection was extremely common in southern Africa during the 1990s, and a substantial minority of infected infants have survived to reach adolescence undiagnosed. Studies have shown a high prevalence of HIV infection in hospitalized adolescents who have features associated with long-standing HIV infection, including stunting and frequent minor illnesses. The authors therefore investigated the epidemiology of HIV infection at the primary care level. Adolescents (aged 10-18 years) attending two primary care clinics underwent HIV and Herpes simplex virus-2 (HSV-2) serological testing, clinical examination, and anthropometry. All were offered routine HIV counselling and testing. Patients attending for acute primary care who were HIV infected were asked about their risk factors. Five hundred ninety-four participants were systematically recruited (97% participation), of whom 88 (15%) were attending for antenatal care. HIV infection prevalence was higher among acute primary care attendees than among antenatal care attendees (17% vs 6%), but for the prevalence of HSV-2 infection, a marker of sexually acquired HIV, the converse was true (4% vs 14%). Seventy (81%) of 86 HIV-positive acute primary care attendees were previously undiagnosed. They had a broad range of presenting complaints, with a median CD4 cell count of 329 cells/muL(interquartile range, 176-485 cells/muL) and a high prevalence of stunting, compared with the corresponding prevalence among HIV-negative attendees (40% vs12%). Maternal transmission was considered to be likely by 69 (80%) of the 86 HIV-positive acute primary care attendees, only one of whom was HSV-2positive. Unrecognized HIV infection was a common cause of primary care attendance. Routine HIV counselling and testing implemented at the primary care level may provide a simple and effective way of identifying older long-term survivors of mother-to-child transmission before the onset of severe immunosuppression and irreversible complications.

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Editors’ note: Adolescents living in countries with longstanding generalised HIV epidemics should be offered HIV testing and counselling by health care providers, regardless of their presenting complaint. Given the high number of infants infected in the 1990s before the introduction of programmes to prevent mother-to-child transmission and evidence that up to a third may be slower progressors, it is estimated that as much as 1 to 2% of all children aged 10 to 15 years in such settings may have HIV infection. That the vast majority of these children will have been infected through vertical transmission is not in doubt. In this study, there was an equal sex distribution, a strong association with maternal but not paternal orphanhood, and a low prevalence of herpes simplex 2 infection. The latter is an independent marker of sexually acquired HIV because it is a highly prevalent sexually transmitted infection among southern Africans. Finally, Zimbabwe instituted effective polices to stop transmission through contaminated blood and blood products early on in its epidemic. The point is that there are thousands and thousands of undiagnosed young adolescents in southern Africa that could benefit from clinical assessment, prophylaxis for opportunistic illness, and antiretroviral therapy initiation before life-threatening illness and chronic complications announce the possibility of HIV infection, if only they had the chance to learn their serostatus.