Study Finds Advanced HIV Disease, Late Diagnosis Among Zimbabwean Adolescents
A new study suggests the effects of longstanding, undiagnosed HIV infection are hanging over a generation of adolescents in Zimbabwe, causing organ damage, chronic ill health, stunted growth, and other problems. The research, in the March 15 issue of Clinical Infectious Diseases, demonstrates the need to reduce barriers to early testing and admission to care for these adolescents.
Little is known about HIV in adolescence because survival from birth to adolescence with HIV without treatment has been considered extremely unlikely. However, lead author Rashida Ferrand, MBBS, MRCP, DTMH, said, “We suspect that there is a substantial and growing burden of long-standing HIV infection and AIDS in this age group, especially in countries where HIV prevalence in pregnant women has been high for over 10 years—giving time for survivors of mother-to-child transmission to grow up.” She and her colleagues from London and Zimbabwe present a case series of 32 adolescents from the Connaught Clinic in Harare, Zimbabwe.
Because of the difficulties and expense of obtaining HIV testing and care, the average delay between the first serious illness to HIV diagnosis was 3.5 years, despite the fact that 75 percent of the parents or guardians suspected HIV infection. Many of the patients’ health care providers must also have considered the possibility of an HIV diagnosis, as more than 40 percent of the participants had taken cotrimoxazole, an antibiotic recommended for prophylaxis against pneumocystis pneumonia and other infections.
“A delayed diagnosis means that patients present late in the course of HIV infection,” said Dr. Ferrand, “by which time they may already have significant and irreversible damage to vital organs such as the heart and lungs, plus an increased risk of serious opportunistic infections with high mortality.” The opportunity for “catch-up” growth on antiretroviral therapy may be lost if it is delayed until late adolescence.
Ferrand et al., Clin Infect Dis. 2007;44:874-878.