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. 2010 Oct 1;51(7):844-51.
doi: 10.1086/656361.

Undiagnosed HIV infection among adolescents seeking primary health care in Zimbabwe

Rashida A Ferrand  1 , Lucia Munaiwa, John Matsekete, Tsitsi Bandason, Kusum Nathoo, Chiratidzo E Ndhlovu, Shungu Munyati, Frances M Cowan, Diana M Gibb, Elizabeth L Corbett
Affiliations

Undiagnosed HIV infection among adolescents seeking primary health care in Zimbabwe

Rashida A Ferrand et al. Clin Infect Dis. .

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.

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Figures

Figure 1
Figure 1
Study recruitment and results of human immunodeficiency virus (HIV) testing. PITC, provider-initiated testing and counseling.
See this image and copyright information in PMC

Comment in

References

    1. AIDS epidemic update. Joint United Nations Programme on HIV and AIDS and World Health Organization; Geneva, Switzerland: 2009.
    1. Newell ML, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, Dabis F. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet. 2004;364(9441):1236–1243. - PubMed
    1. Marston M, Zaba B, Salomon JA, Brahmbhatt H, Bagenda D. Estimating the net effect of HIV on child mortality in African populations affected by generalized HIV epidemics. J Acquir Immune Defic Syndr. 2005;38(2):219–227. - PubMed
    1. Ferrand RA, Corbett EL, Wood R, et al. AIDS among older children and adolescents in Southern Africa: projecting the time course and magnitude of the epidemic. AIDS. 2009;23(15):2039–2046. - PMC - PubMed
    1. Stover J, Walker N, Grassly NC, Marston M. Projecting the demographic impact of AIDS and the number of people in need of treatment: updates to the Spectrum projection package. Sex Transm Infect. 2006;82(suppl 3):iii45–50. - PMC - PubMed