[procaare] Young Africans Suffering Advanced HIV Disease From Delayed Diagnosis

["Science Daily" <procaare@healthnet.org>]

Young Africans Suffering Advanced HIV Disease From Delayed Diagnosis
Source:Infectious Diseases Society of America
Date:February 19, 2007
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Science Daily - A new study suggests the effects of long-standing, 
undiagnosed HIV infection are hanging over a generation of adolescents in 
Zimbabwe, causing organ damage, chronic ill health, stunted growth, and 
other problems. The research demonstrates the need to reduce barriers to 
early testing and admission to care for these adolescents. It appears in the 
March 15 issue of Clinical Infectious Diseases, currently available online.

"We suspect that there is a substantial and growing burden of long-standing 
HIV infection and AIDS in this age group," said lead author Rashida Ferrand, 
MBBS, MRCP, DTMH, "especially in countries where HIV prevalence in pregnant 
women has been high for over ten years--giving time for survivors of 
mother-to-child transmission to grow up." She and her colleagues from London 
and Zimbabwe have recently completed a study of 32 adolescents from the 
Connaught Clinic in Harare, Zimbabwe.

Because of the difficulties and expense of obtaining HIV testing and care, 
the average delay between the first serious illness to HIV diagnosis was 3.5 
years, despite the fact that 75 percent of the parents or guardians 
suspected HIV infection. By the time they sought care, many of the patients 
had long histories of the types of ill health that suggest HIV infection, 
including chronic skin, respiratory, and gastrointestinal symptoms. In 
addition, many of the patients' health care providers must have considered 
the possibility of an HIV diagnosis, as more than 40 percent of the 
participants had taken cotrimoxazole, an antibiotic which the World Health 
Organization recommends be given to HIV-infected children to prevent 
pneumocystis pneumonia and other infections.

"A delayed diagnosis means that patients present late in the course of HIV 
infection," said Dr. Ferrand, "by which time they may already have 
significant and irreversible damage to vital organs such as the heart and 
lungs, plus an increased risk of serious opportunistic infections with high 
mortality." These infections are preventable with antiretroviral therapy 
(ART) and cotrimoxazole.

Earlier diagnosis of HIV infection is paramount, as there is a higher risk 
of death and disease progression in patients who delay starting treatment 
until they have advanced disease. Earlier treatment is also crucial. 
Previous studies show treatment is less effective if started in patients who 
have advanced disease. The opportunity for "catch-up" growth on ART may be 
lost if it is delayed until late adolescence.
"What we are looking at here are the consequences of not having programs to 
prevent maternal-to-child transmission of HIV in the 1990s," said Dr. 
Ferrand. "We need to deal with these children who have already suffered 
terribly from the indirect effects of HIV: orphanhood, impoverishment, and 
the psychological trauma of prolonged illness in parents and siblings. More 
research into the scope of the problem of late-childhood HIV/AIDS and the 
problems faced so stoically by these vulnerable and ignored group of 
patients -- medical, socio-economic, and psychosocial -- will help in the 
development of policy and practice. And we need to strengthen programs to 
prevent maternal-to-child transmission so that we can prevent this problem 
in the future."

Note: This story has been adapted from a news release issued by Infectious 
Diseases Society of America.

Online: http://www.sciencedaily.com/releases/2007/02/070208131541.htm