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Africa: HIV Babies May Grow Up Unaware of Their Infection

Kerry Cullinan

Far more African babies infected with HIV by their mothers may survive to puberty than previously thought - but the health services are ill-equipped to deal with HIV positive teens who need special care.

This is according to a study conducted by researchers based at the Connaught Clinic in Harare, Zimbabwe that was published this week in Clinical Infectious Diseases.

"The findings are quite extraordinary," says researcher Dr Liz Corbett, from the London School of Hygiene and Tropical Medicine, based in Zimbabwe.

"The phenomenon of long-term survival is poorly recognised and until recently has been almost positively resisted by the international HIV community because of the strongly held assumptions that survival from birth to adolescence with HIV was so unlikely without treatment as to be negligible.

"This just doesn't fit with what we see in Zimbabwe and hear from neighbouring counties.

"It is now being realised that these earlier assumptions were wrong and that instead somewhere around 1 in 10 infected infants - and perhaps even as high as 1 in 4 - may survive into late childhood or early adolescence without diagnosis or treatment."

An estimated half a million babies were infected with HIV during birth or breastfeeding last year alone in Africa.

However, late diagnosis is likely to have a significant effect on their future health and long term survival, warn the researchers.

"Early diagnosis of HIV is very important," says Dr Rashida Ferrand, who also worked on the study.

"A delayed diagnosis means that patients have a much higher risk of developing serious opportunistic infections and may have significant and irreversible damage to vital organs as well as a higher risk of death. We also know that antiretroviral therapies are less effective if started in patients with advanced disease."

Corbett adds that no concerted effort has been made to provide diagnostic or treatment programmes for older children and teens "despite an epidemic that is becoming increasingly obvious to anyone providing routine medical care in Southern or East Africa".

It is important to recognise that these children may have already suffered terribly from the indirect effects of HIV, such as orphanhood, impoverishment and the psychological trauma of prolonged illness in parents and siblings, argues Dr Ferrand.

"Simply caring for these patients in existing services is not ideal because they have problems unique to their age-group and circumstances," she says.

These include a lack of awareness of their HIV status, their emerging sexuality, caring for sick parents and coping with the social and economic consequences of orphanhood. "Provision of effective HIV care and treatment will require additional support and special services to deal with these problems," argues Ferrand.

Some of the measures needed include support for parents or guardians reluctant to tell the child what their problem is; a focus on the chronic problems associated with HIV such as short stature and delayed puberty and counselling for those who are sexually active.

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