HIV in late childhood and adolescence a growing problem

Scientists have highlighted for the first time the plight of the growing number of older children and adolescents living with undiagnosed HIV and AIDS in Africa. In a study published today in Clinical Infectious Diseases, Wellcome Trust researchers claim that delay in recognising this problem means that the needs of this important group are not being met.

It is estimated that half a million babies were infected with HIV during birth or breastfeeding in 2006, passed down from their mothers. It was assumed that their chances of survival to adulthood were negligible. However, a new study, carried out by researchers based at the Connaught Clinic in Harare, Zimbabwe, shows that older children and adolescent with AIDS have all of the features that would be expected from long-term survivors of infant HIV infection.

"The findings are quite extraordinary," says Dr Liz Corbett, a Wellcome Trust Senior Clinical Fellow in Tropical Medicine from the London School of Hygiene and Tropical Medicine, based in Zimbabwe. "The phenomenon of long-term survival is poorly recognised and until recently has been almost positively resisted by the international HIV community because of the strongly held assumptions that HIV in late childhood is very unusual, and that survival from birth to adolescence with HIV was so unlikely without treatment as to be negligible. This just doesn’t fit with what we see in Zimbabwe and hear from neighbouring counties.

"It is now being realised that these earlier assumptions were wrong and that instead somewhere around 1 in 10 infected infants – and perhaps even as high as 1 in 4 – may survive into late childhood or early adolescence without diagnosis or treatment."

However, late diagnosis is likely to have a significant effect on their future health and long term survival, warn the researchers.

"Early diagnosis of HIV is very important," says Dr Rashida Ferrand, a Wellcome Trust Research Training Fellow. "A delayed diagnosis means that patients have a much higher risk of developing serious opportunistic infections and may have significant and irreversible damage to vital organs such as heart and lung as well as a higher risk of death. We also know that antiretroviral therapies (ART) are less effective if started in patients with advanced disease."

Dr Ferrand and Dr Corbett argue that there is a need for more services aimed at older children and adolescents to provide accessible and sympathetic HIV testing and treatment services, counselling and support, and drug formulations for low-weight individuals whose growth may have been stunted by undiagnosed HIV.

"Because of the previous assumption that HIV-infected infants did not survive to adolescence, no concerted effort has been made to provide diagnostic or treatment programmes for this age-group, despite an epidemic that is becoming increasingly obvious to anyone providing routine medical care in Southern or East Africa," says Dr Corbett.