Delayed recognition of human immunodeficiency virus infection in preadolescent children.
Thirty-two (18%) of 181 children cared for at our institution who were infected with the human immunodeficiency virus type 1 (HIV-1) were first seen, and HIV was diagnosed, when they were 4 years of age and older. Initial complaints or diagnoses for these children included the following: hematologic disorders (5) (3 idiopathic thrombocytopenic purpura, 1 neutropenia, 1 anemia); recurrent bacterial infections (10); Pneumocystis carinii pneumonia (3); developmental delay (1); skin disorders (2) (1 genital wart, 1 chronic zoster); weight loss (3); malignancy (1); and nephropathy (1). Eight children were referred for evaluation because of maternal HIV-1 infection. The risk factors for HIV-1 infection included maternal/perinatal exposure (22), perinatal blood transfusion (6), blood transfusion during infancy (2), and sexual abuse (2). Ten (31%) of the 32 children have subsequently died. The longest survival from perinatal infection was 12 years. HIV-1 infection in children can result in a prolonged clinical latency and can masquerade as other pathologic conditions. The absence of clinical symptoms in older children at risk for HIV-1 infection should not deter HIV testing.
Persaud
D
D
Department of Pediatrics, New York University Medical Center/Bellevue Hospital Center, New York, NY 10016.
Chandwani
S
S
Rigaud
M
M
Leibovitz
E
E
Kaul
A
A
Lawrence
R
R
Pollack
H
H
DiJohn
D
D
Krasinski
K
K
Borkowsky
W
W
D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D015497:HIV-1; D006801:Humans; D008297:Male; D016019:Survival Analysis