Young Africans Suffering Advanced HIV Disease From Delayed Diagnosis

"We suspect that there is a substantial and growing burden of long-standing HIV infection and AIDS in this age group," said lead author Rashida Ferrand, MBBS, MRCP, DTMH, "especially in countries where HIV prevalence in pregnant women has been high for over ten years--giving time for survivors of mother-to-child transmission to grow up." She and her colleagues from London and Zimbabwe have recently completed a study 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. By the time they sought care, many of the patients had long histories of the types of ill health that suggest HIV infection, including chronic skin, respiratory, and gastrointestinal symptoms. In addition, many of the patients' health care providers must have considered the possibility of an HIV diagnosis, as more than 40 percent of the participants had taken cotrimoxazole, an antibiotic which the World Health Organization recommends be given to HIV-infected children to prevent 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." These infections are preventable with antiretroviral therapy (ART) and cotrimoxazole.

Earlier diagnosis of HIV infection is paramount, as there is a higher risk of death and disease progression in patients who delay starting treatment until they have advanced disease. Earlier treatment is also crucial. Previous studies show treatment is less effective if started in patients who have advanced disease. The opportunity for "catch-up" growth on ART may be lost if it is delayed until late adolescence.

"What we are looking at here are the consequences of not having programs to prevent maternal-to-child transmission of HIV in the 1990s," said Dr. Ferrand. "We need to deal with these children who have already suffered terribly from the indirect effects of HIV: orphanhood, impoverishment, and the psychological trauma of prolonged illness in parents and siblings. More research into the scope of the problem of late-childhood HIV/AIDS and the problems faced so stoically by these vulnerable and ignored group of patients -- medical, socio-economic, and psychosocial -- will help in the development of policy and practice. And we need to strengthen programs to prevent maternal-to-child transmission so that we can prevent this problem in the future."