title: Human immunodeficiency virus infection in Saudi Arabian children: transmission, clinical manifestations and outcome.
abstract: BACKGROUND
  Vertical transmission from mother to infant is the most common mode of transmission of HIV infection in children. Data on pediatric HIV in the Middle East and Gulf region are scarce. We describe the spectrum, characteristics and outcome of HIV infection in Saudi children.
  
  
  METHODS
  We collected descriptive data on HIV-infected or exposed children seen at the King Faisal Hospital and Research Centre (KFSH&RC) between 1986 and 2003.
  
  
  RESULTS
  Sixty-three children had proven HIV infection. The source of infection was perinatal transmission in 63.5% of cases and contaminated blood or blood products transfusion in 34.5%. Median age at diagnosis was 6 years. In 42 patients for whom complete records were available, 90% were delivered by spontaneous vaginal delivery and 10% by cesarean delivery. Ninety-three percent of infected infants were breastfed throughout infancy. The complete medical records were available for 66% of children; for the remainder, part of the records could not be retrieved. Thirteen percent had an AIDS-defining opportunistic infection, with disseminated cytomegalovirus (CMV) infection being the most common (37.5%). All cases received antiretroviral therapy starting in 1997. Of those who received highly active antiretroviral therapy, 79% were compliant with treatment and had a sustained virologic response below the detectable level. Seventy-five percent of those diagnosed before 1995 died compared with 7.7% diagnosed later.
  
  
  CONCLUSIONS
  Effective preventive measures, such as antiretroviral prophylaxis, cesarean delivery, and abstention from breastfeeding are not being applied. This could be largely due to lack of knowledge among patients and healthcare providers. Physicians must recognize the signs and symptoms of HIV infection, and have a high index of suspicion so that infected children are diagnosed early and referred to a specialized center for treatment and follow-up.
authors.affiliation: Maternity and Children Hospital, Medina, Saudi Arabia.
authors.forename: Faisal
authors.initials: F
authors.lastname: Kordy
authors.forename: Sami
authors.initials: S
authors.lastname: Al-Hajjar
authors.forename: Husn H
authors.initials: HH
authors.lastname: Frayha
authors.forename: Riyadh
authors.initials: R
authors.lastname: Al-Khlaif
authors.forename: Dayel
authors.initials: D
authors.lastname: Al-Shahrani
authors.forename: Javed
authors.initials: J
authors.lastname: Akthar
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D001803:Blood Transfusion; D001942:Breast Feeding / Q000453:epidemiology; D002585:Cesarean Section; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D009894:Opportunistic Infections / Q000453:epidemiology*; D010353:Patient Education as Topic; D012529:Saudi Arabia / Q000453:epidemiology