title: Undiagnosed HIV infection among adolescents seeking primary health care in Zimbabwe.
abstract: BACKGROUND
  Mother-to-child transmission of human immunodeficiency virus (HIV) infection was extremely common in southern Africa during the 1990s, and a substantial minority of infected infants have survived to reach adolescence undiagnosed. Studies have shown a high prevalence of HIV infection in hospitalized adolescents who have features associated with long-standing HIV infection, including stunting and frequent minor illnesses. We therefore investigated the epidemiology of HIV infection at the primary care level.
  
  
  METHODS
  Adolescents (aged 10-18 years) attending two primary care clinics underwent HIV and Herpes simplex virus-2 (HSV-2) serological testing, clinical examination, and anthropometry. All were offered routine HIV counseling and testing. Patients attending for acute primary care (APC) who were HIV infected were asked about their risk factors.
  
  
  RESULTS
  Five hundred ninety-four participants were systematically recruited (97% participation), of whom 88 (15%) were attending for antenatal care. HIV infection prevalence was higher among APC attendees than among antenatal care attendees (17% vs 6%; P < .007), but for the prevalence of HSV-2 infection, a marker of sexually acquired HIV, the converse was true (4% vs 14%; P < .002). Seventy (81%) of 86 HIV-positive APC attendees were previously undiagnosed. They had a broad range of presenting complaints, with a median CD4 cell count of 329 cells/microL (interquartile range, 176-485 cells/microL) and a high prevalence of stunting, compared with the corresponding prevalence among HIV-negative attendees (40% vs 12%; P < .001). Maternal transmission was considered to be likely by 69 (80%) of the 86 HIV-positive APC attendees, only one of whom was HSV-2 positive.
  
  
  CONCLUSIONS
  Unrecognized HIV infection was a common cause of primary care attendance. Routine HIV counseling and testing implemented at the primary care level may provide a simple and effective way of identifying older long-term survivors of mother-to-child transmission before the onset of severe immunosuppression and irreversible complications.
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. rabferr@gmail.com
authors.forename: Rashida A
authors.initials: RA
authors.lastname: Ferrand
authors.forename: Lucia
authors.initials: L
authors.lastname: Munaiwa
authors.forename: John
authors.initials: J
authors.lastname: Matsekete
authors.forename: Tsitsi
authors.initials: T
authors.lastname: Bandason
authors.forename: Kusum
authors.initials: K
authors.lastname: Nathoo
authors.forename: Chiratidzo E
authors.initials: CE
authors.lastname: Ndhlovu
authors.forename: Shungu
authors.initials: S
authors.lastname: Munyati
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.forename: Diana M
authors.initials: DM
authors.lastname: Gibb
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Corbett
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D002648:Child; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D008297:Male; D015995:Prevalence; D011320:Primary Health Care; D012307:Risk Factors; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D015483:HIV Antibodies
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