Late diagnosis in adolescence of vertically acquired HIV infection

In an oral presentation, M Prime and coworkers presented findings from an investigation of clinical characteristics and circumstances in a group of vertically infected adolescents diagnosed in the UK or Ireland at 13 years of age or above. This study was conducted by investigators from: St George’s Hospital, London, London School of Hygiene and Tropical Medicine, St Mary’s Hospital, London, MRC Clinical Trials Unit, UCL Institute of Child Health and Mortimer Market Centre, London.

In the UK and Ireland, HIV positive children diagnosed at <16 years of age are reported to the National Study of HIV in Pregnancy and Childhood and followed up through the Collaborative HIV Paediatric Study. New HIV diagnoses made at adult services are reported to the Health Protection Agency and the Survey of Prevalent HIV Infections Diagnosed collects annual data on patients receiving care.

The investigators identified 38 cases; of these 19 (50%) were male and 36 (95%) were black African. 34 (89%) were born in sub-Saharan Africa, and three of these were diagnosed before arrival in the UK/Ireland.

The median age of the adolescents at diagnosis was 14.3 years (IQR: 13.6-15 years) with a median of 1.8 years (IQR: 0.2-5.6 years) between arrival in the UK and HIV diagnosis. 24 (63%) of those diagnosed presented with symptoms; the others were tested for HIV as part of screening for STIs or following diagnosis of a family member. Their median CD4 count at diagnosis was 208 cells/mm³ (IQR: 23-251 cells/mm³) and 11 developed AIDS before or within 2 years of diagnosis.

Thirty two patients began antiretroviral therapy (ART), the majority (88%) within a year of their HIV diagnosis.

The investigators wrote: “Young people with vertically acquired HIV infection are surviving childhood without ART and being diagnosed in adolescence. In this cohort a third were asymptomatic, highlighting the importance of testing all children born to HIV infected women, regardless of age or symptoms.” They added: “Increased awareness amongst clinicians is urgently required to prevent presentation with advanced disease and to reduce ongoing transmission as this population become sexually active.”

Prime K, Ferrand R, Foster C et al. First presentation of vertically acquired HIV infection in adolescence. 14th Annual BHIVA Conference, Dublin, 2008. HIV Medicine, 9 Suppl. 1. Abstract O2.