title: HIV infection presenting in older children and adolescents: a case series from Harare, Zimbabwe.
abstract: BACKGROUND
  Symptomatic human immunodeficiency virus (HIV) infection during late childhood and adolescence may be an emerging problem in southern Africa, but it is one that is poorly described. We investigated social and clinical features in patients of this age group presenting to a HIV treatment clinic with special adolescent services in Harare, Zimbabwe.
  
  
  METHODS
  All patients aged 8-19 years and their guardians who attended an adolescent HIV treatment clinic were asked to consent to an interview and a review of medical notes.
  
  
  RESULTS
  Of 32 patients, 17 (53%) were male. The median CD4 cell count at presentation was 101 cells/microL (interquartile range, 35-197 cells/microL). Sixty-two percent experienced stunting (mean Z score for height-for-age, -2.55; 95% CI, -2.00 to -3.10), and all presented with World Health Organization stage 3 or 4 HIV infection. The median age at the first HIV test was 11 years, with a median of 3.5 years delay since the first HIV-related illness. Recurrent respiratory tract infections, skin complaints, diarrhea, and past tuberculosis were the most common HIV-related complaints. Seventeen patients (55%) were double orphans, and 10 (62%) surviving parents were known to be HIV positive.
  
  
  CONCLUSIONS
  In this small study, HIV-infected adolescents were profoundly immunosuppressed, with characteristics suggesting long-standing HIV infection. The equal sex distribution and high incidence of parental and sibling mortality were consistent; the majority of children had HIV-infected parents and, therefore, were potentially long-term survivors of HIV infection due to mother-to-child transmission. Greater recognition of the substantial burden of undiagnosed HIV infection and acquired immunodeficiency syndrome in this age group is needed, together with services aimed at reducing barriers to earlier diagnosis and initiation of treatment.
authors.affiliation: Mortimer Market Centre, Camden Primary Care Trust, London WC1E 6AU, UK. rashida.ferrand@camdenpct.nhs.uk
authors.forename: Rashida A
authors.initials: RA
authors.lastname: Ferrand
authors.forename: Ruedi
authors.initials: R
authors.lastname: Luethy
authors.forename: Filda
authors.initials: F
authors.lastname: Bwakura
authors.forename: Hilda
authors.initials: H
authors.lastname: Mujuru
authors.forename: Robert F
authors.initials: RF
authors.lastname: Miller
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Corbett
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D017677:Age Distribution; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002648:Child; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D010287:Parent-Child Relations; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012959:Socioeconomic Factors; D015996:Survival Rate; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents