|Year : 2008 | Volume
| Issue : 2 | Page : 73-75
HIV infection in adolescents: A rising concern
Megha Modi, Nidhi Sharma, Archana Sharma, YS Marfatia
Department of Skin and V.D., Medical College and SSG Hospital, Vadodara, India
Y S Marfatia
Department of Skin and V.D., Medical College and SSG Hospital, Vadodara
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Almost a third of all people with Human Immunodeficiency Virus (HIV)/(AIDS) Acquired Immunodeficiency Syndrome are between the ages of 15 and 24. Every minute, six young people under the age of 25 become infected with HIV. This study of HIV infection was carried out over a two-year period with 33 HIV-positive adolescents, at SSG hospital, Vadodara. The most common mode of transmission (MOT) was the vertical route in 21(64%) cases followed by the sexual route in four (12%) cases. The mean time for disease progression was 13 years in cases acquiring infection through vertical transmission (VT). Reasons for slow progression in these cases, in spite of the high prevalence of malnutrition and infectious diseases in a developing country like India, should be studied. Both parents were positive in 12 of 21 VT cases and eight were orphans. Multiple cases in the same family made treatment and care difficult. Only eight of the 21 VT cases were tested, due to positivity in their parents, while the rest were tested on being symptomatic, suggesting delayed testing. Late diagnosis led to a delay in the initiation of antiretroviral treatment (ART), influencing the growth and development of adolescents. Twenty-one cases sought treatment when they had already developed AIDS, thus preventing us from early intervention. Nine cases were on ART. These cases faced problems like dose adjustments, adherence, and availability of pediatric formulations.
Keywords: Adolescent, HIV, epidemiology
|How to cite this article:|
Modi M, Sharma N, Sharma A, Marfatia Y S. HIV infection in adolescents: A rising concern. Indian J Sex Transm Dis 2008;29:73-5
|How to cite this URL:|
Modi M, Sharma N, Sharma A, Marfatia Y S. HIV infection in adolescents: A rising concern. Indian J Sex Transm Dis [serial online] 2008 [cited 2019 Nov 15];29:73-5. Available from: http://www.ijstd.org/text.asp?2008/29/2/73/48728
| Introduction|| |
Adolescence is a distinct age group (10-19 years) with complex needs, because of the physical and psychological development during puberty and the steps needed to move toward independence and adulthood. They are at their hormonal peak, want to look their best, and perform the best in order to establish their identity in society.
This age group is increasingly affected with HIV infection. Data from the Center for Disease Control (2006), suggests that at least one in four new HIV infections occurs in the <22 years age group.  The World Health Organization (WHO) estimates that 10.3 million youth aged 15 to 24 years are living with HIV/AIDS (most without knowing they are infected), and half of all new infections occur among young people, on a global basis.  The adolescents with HIV infection have to face numerous physical, social, economical, and psychological challenges. They face difficulties like acceptance of their positive status and have the problem of a care provider, with multiple cases in the same family. Many of them may have lost their parents. Moreover, they suffer developmental delay and have to take lifelong treatment. With all these issues, there are uncertainties in the future regarding their health, education, career, and marriage.
The present study was carried out to contemplate the clinico-epidemiological profile of HIV infection in adolescents and to find out the constraints in the care and management of the same.
| Materials and methods|| |
Adolescents attending the AIDS Clinic were enrolled over a two-year period. Their clinico-epidemiological profile was studied in terms of mode of transmission (MOT), parents' and siblings' sero-status, reasons for testing, disease progression, and clinical staging at the time of presentation, which was recorded in the adolescent HIV register. All patients were clinically evaluated and treated for opportunistic infections. Baseline investigations including hemogram, erythrocyte sedimentation rate (ESR), urine examination, serum VDRL (Venereal Disease Research Laboratory test), serum HBsAg, liver function tests (LFTs) and renal function tests (RFTs) were carried out in each patient. Chest X-ray and ultrasonography of the abdomen were done in all cases, to rule out focus of tuberculosis. CD4 count was done before starting ART. Management difficulties were studied in terms of provision and availability of pediatric formulations and dose adjustments, and long-term adverse reactions of ART.
| Results|| |
During this two-year period of study, 33 adolescent HIV cases were registered. The number of males was twice that of females (22 vs. 11). Most common MOT was VT [Table 1].
Both parents were positive in 12 of the 21 VT cases and eight of these were orphans [Table 2].
The mean time of progression of HIV was longer in cases where the patients had acquired infection by VT. Sexually transmitted cases progressed rapidly, which could have been due to concomitant STI (Sexually Transmitted Infection) [Table 3].
Parent positivity led to testing in only eight out of the 21 cases that had acquired infection through VT, which was suggestive of late testing or keeping the status secret for fear of social stigma or discrimination [Table 4].
Twenty-one cases sought treatment when they had already developed AIDS, hampering the opportunity to intervene early. Nine of these 33 adolescent HIV cases were on ART. In one of the cases, a male aged 16 years was on Abacavir, Lamivudine, and Efavirenz, and as he gained weight during the course of treatment he could be put on a fixed dose regimen of Tenofovir, Emtricitabine, and Efavirenz (600), signifying the need for continuous weight monitoring and changing of dose accordingly. There was another patient who was on ART and later developed cardiomyopathy and succumbed to it. There were two pairs of twins, one seroconcordant and the other serodiscordant. In the seroconcordant twin, the first born had developmental delay as well as faster HIV progression as compared to the other twin. In the discordant twins, the first born was HIV positive, whereas, the second born had escaped HIV infection.
| Discussion|| |
In our study, a majority of the cases had vertical transmission as the most common MOT. Harrison A et al. , also reported VT to be the most common MOT (70%).  Vertical transmission cases had at least one or two cases in the family, raising the question of the care provider. This issue needs to be emergently addressed as it can be prevented with effective implementation of prevention of parent to child transmission (PPTCT). Twelve percent of the cases acquired infection via the sexual route. While according to the 2001 statistics from the Center for Disease Control (CDC), a majority of cases in the age group of 13-19 years (66%) had the sexual route as the most common MOT.  At this juncture, glancing at the future, with an ever increasing number of street children and early initiation of sexual activity, emphasis should be on the importance of proper adolescent sex education.
Cases acquiring infection through VT and presenting in adolescence are slow progressors as compared to cases where infection is acquired through sexual transmission. The mean time for disease progression is 13 years in VT cases. According to Moatlhodi Kgosimore et al. , about 20% of the children infected with HIV develop AIDS in the first year of their lives, and most of them die by the age of four. As for the others, up to 80% of the infected children, develop symptoms of HIV/AIDS at school entry age (seven to nine years) or even during adolescence. A study conducted at Kenya reported that at least 89% of the children infected with HIV-1 die before their third birthday, and long-term nonprogressors are rare.  As against the prediction by western researchers, HIV disease progression is slow in spite of high prevalence of anemia, malnutrition, and infectious diseases (TB) in these cases, the reasons for this need to be researched.
A majority of the patients had presented when they had already progressed to AIDS. As per a study conducted by Ferrand et al. , 62% of the cases in their study experienced stunting, and all presented with WHO stage 3 or 4 HIV infection.  This suggests that the treatment seeking behavior of the cases need to be modified. Early diagnosis and intervention may help to prevent developmental delay.
Orphans suffering from AIDS are an issue of grave concern. According to a study by Ruland et al., the number of orphans worldwide would be decreasing except for AIDS.  In a study by Ferrand et al. , 55% of the cases acquiring infection through VT were orphans.  These AIDS orphans may be devoid of many opportunities which are available to normal adolescents.
| Conclusion|| |
Greater recognition of the substantial burden of undiagnosed human immunodeficiency virus 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. Early diagnosis and initiation of antiretroviral treatment may help to prevent developmental delay and organ-specific manifestations like cardiomyopathy, nephropathy, etc.
| References|| |
|1.||Rudy BJ. Textbook of Pediatric HIV care. Adolescent and HIV. |
|2.||Adolescent HIV infection and disease. National institute of child health and human development (NICHD) [cited in 2006]. Available from:www.nichd.nih.gov. |
|3.||Harris A. Clinical manifestations of adolescents with HIV/AIDS in Jamaica. West Indian Med J 2008;57:No. 3. Available from: www.caribbean.scielo.org. |
|4.||Kgosimore M. The effects of vertical transmission on the spread of HIV/AIDS in the presence of treatment. Vol. 3. 2006. p. 297-312. Available from:www.mbejournal.org/.7. |
|5.||Ferrand RA, Luethy R, Bwakura F, Mujuru H, Miller RF, Corbett EL. HIV infection presenting in older children and adolescents: A case series from Harare, Zimbabwe. 2007;44:874-8. Available from:www.ncbi.nlm.nih.gov/pubmed/17304463. |
|6.||Ruland CD. Orphaned and Vulnerable in the Time of HIV/AIDS. Youth Issues Paper No. 6, [cited in 2005]. Available from:www.fhi.org. |
[Table 1], [Table 2], [Table 3], [Table 4]
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