title: Chronic Morbidity Among Older Children and Adolescents at Diagnosis of HIV Infection.
abstract: Substantial numbers of children with HIV present to health care services in older childhood and adolescence, previously undiagnosed. These "slow-progressors" may experience considerable chronic ill health, which is not well characterized. We investigated the prevalence of chronic morbidity among children aged 6-15 years at diagnosis of HIV infection.
  
  
  
  A cross-sectional study was performed at 7 primary care clinics in Harare, Zimbabwe. Children aged 6-15 years who tested HIV positive following provider-initiated HIV testing and counseling were recruited. A detailed clinical history and standardized clinical examination was undertaken. The association between chronic disease and CD4 count was investigated using multivariate logistic regression.
  
  
  
  Of the 385 participants recruited [52% female, median age 11 years (interquartile range 8-13)], 95% were perinatally HIV infected. The median CD4 count was 375 (interquartile range 215-599) cells per cubic millimeter. Although 78% had previous contact with health care services, HIV testing had not been performed. There was a high burden of chronic morbidity: 23% were stunted, 21% had pubertal delay, 25% had chronic skin disease, 54% had a chronic cough of more than 1 month-duration, 28% had abnormal lung function, and 12% reported hearing impairment. There was no association between CD4 count of <500 cells per cubic millimeter or <350 cells per cubic millimeter with WHO stage or these chronic conditions.
  
  
  
  In children with slow-progressing HIV, there is a substantial burden of chronic morbidity even when CD4 count is relatively preserved. Timely HIV testing and prompt antiretroviral therapy initiation are urgently needed to prevent development of chronic complications.
authors.affiliation: *Biomedical Research and Training Institute, Harare, Zimbabwe; †Liverpool School of Tropical Medicine, Liverpool, United Kingdom; ‡University of Zimbabwe, Harare, Zimbabwe; §Harare City Health, Zimbabwe; ‖London School of Hygiene and Tropical Medicine, London, United Kingdom; and ¶National TB Reference Laboratory, Research Centre Borstel, Germany.
authors.forename: Grace
authors.initials: G
authors.lastname: McHugh
authors.forename: Jamie
authors.initials: J
authors.lastname: Rylance
authors.forename: Hilda
authors.initials: H
authors.lastname: Mujuru
authors.forename: Kusum
authors.initials: K
authors.lastname: Nathoo
authors.forename: Prosper
authors.initials: P
authors.lastname: Chonzi
authors.forename: Ethel
authors.initials: E
authors.lastname: Dauya
authors.forename: Tsitsi
authors.initials: T
authors.lastname: Bandason
authors.forename: Victoria
authors.initials: V
authors.lastname: Simms
authors.forename: Katharina
authors.initials: K
authors.lastname: Kranzer
authors.forename: Rashida A
authors.initials: RA
authors.lastname: Ferrand
mesh_terms: D000293:Adolescent; D018791:CD4 Lymphocyte Count; D002648:Child; D002908:Chronic Disease; D003376:Counseling; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008171:Lung Diseases / Q000150:complications*; D008297:Male; D015995:Prevalence; D011320:Primary Health Care; D012129:Respiratory Function Tests; D015030:Zimbabwe