HIV infection presenting in older children and adolescents: A case series from Harare, Zimbabwe
HIV infection presenting in older children and adolescents: A case series from Harare, Zimbabwe
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DOI：
10.1086/511873
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发表时间：
2007-03-15
影响因子：
11.8
通讯作者：
Corbett, Elizabeth L.
中科院分区：
文献类型：
--
作者：
Ferrand, Rashida A.;Luethy, Ruedi;Corbett, Elizabeth L.
背景在南部非洲，儿童后期和青春期出现的有症状的人体免疫缺陷病毒（艾滋病毒）感染可能是一个新出现的问题，但对这一问题的描述很少。我们调查了在津巴布韦哈拉雷的一家艾滋病治疗诊所接受特殊青少年服务的这一年龄组患者的社会和临床特征。所有参加青少年艾滋病毒治疗诊所的8-19岁患者及其监护人都被要求同意接受采访和病历审查。结果。32例患者中，17例（53%）为男性。就诊时的中位CD 4细胞计数为101个细胞/μ L（四分位距，35-197个细胞/μ L）。62%的人经历过发育迟缓（年龄别身高的平均Z评分为-2.55; 95%CI为-2.00至-3.10），并且都表现为世界卫生组织3期或4期HIV感染。第一次艾滋病毒检测的中位年龄为11岁，自第一次艾滋病毒相关疾病以来的中位延迟时间为3.5年。反复呼吸道感染、皮肤病、腹泻和既往结核病是最常见的HIV相关主诉。17名患者（55%）是双孤儿，10名（62%）幸存的父母已知是HIV阳性。在这项小型研究中，艾滋病毒感染的青少年严重免疫抑制，其特征表明长期感染艾滋病毒。性别分布均衡，父母和兄弟姐妹死亡率高，这一点是一贯的;大多数儿童的父母都感染了艾滋病毒，因此，由于母婴传播，他们可能是艾滋病毒感染的长期幸存者。需要更多地认识到该年龄组未确诊的艾滋病毒感染和获得性免疫缺陷综合症的巨大负担，并提供旨在减少早期诊断和开始治疗障碍的服务。
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/mu L (interquartile range, 35-197 cells/mu L). 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.