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Delayed recognition of human immunodeficiency virus infection in preadolescent children
D Persaud1, S Chandwani, M Rigaud
1Department of Pediatrics, New York University Medical Center/Bellevue Hospital Center, New York, NY 10016.
Insights
Human immunodeficiency virus type 1 (HIV-1) infection in children can present later in life, mimicking other conditions. Early HIV testing is crucial, even without apparent symptoms in at-risk youth.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- Human immunodeficiency virus type 1 (HIV-1) infection in children can exhibit prolonged clinical latency.
- Delayed diagnosis in children may lead to the condition mimicking other diseases.
- Understanding the varied presentations of pediatric HIV-1 is vital for timely intervention.
Purpose of the Study:
- To analyze the characteristics and outcomes of children diagnosed with HIV-1 at age 4 or older.
- To highlight the diverse initial clinical presentations in this cohort.
- To emphasize the importance of considering HIV-1 in older children with unexplained symptoms.
Main Methods:
- Retrospective review of medical records for children diagnosed with HIV-1 at the institution.
- Analysis of initial complaints, diagnoses, risk factors, and survival data.
- Categorization of presenting conditions including hematologic, infectious, developmental, and other disorders.
Main Results:
- 18% (32/181) of pediatric HIV-1 cases were diagnosed at age 4+.
- Common initial issues included recurrent bacterial infections (10), hematologic disorders (5), and Pneumocystis carinii pneumonia (3).
- Risk factors included maternal/perinatal exposure (22) and blood transfusions (8). 31% of these children died.
Conclusions:
- HIV-1 infection in children can have a long latency period and present atypically.
- Delayed diagnosis is common when symptoms mimic other conditions.
- HIV testing should not be withheld in older children at risk, even if asymptomatic.
Abstract:
Thirty-two (18%) of 181 children cared for at our institution who were infected with the human immunodeficiency virus type 1 (HIV-1) were first seen, and HIV was diagnosed, when they were 4 years of age and older. Initial complaints or diagnoses for these children included the following: hematologic disorders (5) (3 idiopathic thrombocytopenic purpura, 1 neutropenia, 1 anemia); recurrent bacterial infections (10); Pneumocystis carinii pneumonia (3); developmental delay (1); skin disorders (2) (1 genital wart, 1 chronic zoster); weight loss (3); malignancy (1); and nephropathy (1). Eight children were referred for evaluation because of maternal HIV-1 infection. The risk factors for HIV-1 infection included maternal/perinatal exposure (22), perinatal blood transfusion (6), blood transfusion during infancy (2), and sexual abuse (2). Ten (31%) of the 32 children have subsequently died. The longest survival from perinatal infection was 12 years. HIV-1 infection in children can result in a prolonged clinical latency and can masquerade as other pathologic conditions. The absence of clinical symptoms in older children at risk for HIV-1 infection should not deter HIV testing.