Author: Mark Mascolini
05 February 2010
Nearly half of 10- to 18-year-olds admitted to two hospitals in Harare, Zimbabwe had HIV infection. Opportunistic infections and long-term consequences of HIV explained most of the admissions.
Researchers prospectively studied 301 adolescents admitted to two public hospitals from September 2007 through April 2008, testing them for HIV and asking them to complete a questionnaire. Of the adolescents invited to participate in the study, 94% agreed.
Clinicians diagnosed HIV in 139 adolescents (46%) who had a median age of 13 years (interquartile range 11 to 16) and a median CD4 count of 151 cells/µL (interquartile range 57 to 328). About one quarter of the adolescents with HIV found out about their infection only during this study.
HIV-infected children did not differ significantly from uninfected children in age or gender (57% were boys). Only 4 children (1.3%) had herpes simplex virus type 2 infection.
Adolescents with HIV were more likely to have stunted growth (z score below -2, 52% versus 23%, P < 0.001), to have delayed puberty (15% versus 2%, P < 0.001), and to be maternal orphans or have an HIV-positive mother (73% versus 17%, P < 0.001).
Among adolescents with HIV, 69% of admissions were for infection, usually tuberculosis or pneumonia, whereas 19% of HIV-negative children were admitted for infection. Significantly more children with HIV died during the study (22% versus 7%, P < 0.001), usually because of advanced HIV and chronic conditions.
Other findings indicate that most children with HIV were infected by mother-to-child transmission, a result showing that long-term survival with HIV after vertical infection is not unusual.
“African countries and other places where HIV infection in adults is common need to recognize that the burden of HIV in their acutely unwell adolescents is likely to increase over the next few years,” write the editors of PLoS Medicine, which published the study.
“To deal with this emerging aspect of the AIDS epidemic,” they continue, “measures must be introduced to ensure early diagnosis of HIV in this previously neglected age group so that treatment can be started before HIV-positive adolescents become critically ill.”
Source: Rashida A. Ferrand, Tsitsi Bandason, Praise Musvaire, Natasha Larke, Kusum Nathoo, Hilda Mujuru, Chiratidzo E. Ndhlovu, Shungu Munyati, Frances M. Cowan, Diana M. Gibb, Elizabeth L. Corbett. Causes of acute hospitalization in adolescence: burden and spectrum of HIV-related morbidity in a country with an early-onset and severe HIV epidemic: a prospective survey. PLoS Medicine. 2010; 7(2): e1000178.
Complete article provided by PLoS Medicine, an open-access journal