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South Africa

Unexpected HIV infections in children: 

2004-10: After reporting 14 children with unexpected HIV infections identified 1999-2003 (see below), doctors at Stellenbosch University and Tygerberg Children’s Hospital continued to see and record unexpected infections. In 2011, they reported 10 more children with unexpected infections, as follows: “Two children were never hospitalised prior to HIV diagnosis, one of these had 2 HIV-infected household contacts. Eight cases had been hospitalised across 7 hospitals prior to HIV diagnosis, 3 as neonates. Six of 8 received intravenous antibiotics during hospitalisation and one had a tonsillectomy performed. At diagnosis, the median age was 66 months…” Nine of 10 children had HIV-negative mothers; the one child with an HIV-positive mother was uninfected at 5 months old but was later found to be HIV-positive despite no breastfeeding. Source: Slogrove S, Rabie H, Cotton M. Non-vertical transmission of HIV in children: more evidence from the Western Cape, South Africa. Poster presented at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention, July, 2011, Rome. Available at (search for Slogrove): http://www.abstract-archive.org/ (accessed 10 December 2018).

2006: In early 2005 tests identified an unexpected HIV infection in a young child, Anna, in Western Cape. The parents are “contemplating legal action against the Western Cape Health Department because they are convinced [the child] was infected with HIV during one of many visits to state hospitals.” The same article mentions two other cases of South African children with unexpected HIV infections: (a) in Johannesburg High Court parents of Baby M are asking Chris Hani-Baragwanath Hospital and health authorities for Rand 49 million (US$ 7.2 million) for infecting their child with HIV; (b) in 2007 “Western Cape health authorities… reached an undisclosed out-of-court settlement with a couple whose baby daughter was infected with HIV after her stay at two state hospitals.” Source:  Maughan K. Patients demand answers to HIV puzzle. Cape Times 27 August 2007.

2005: In a 2005 random sample national survey, children aged 2-14 years got HIV at the rate of 0.5% per year. The survey used the BED test to distinguish old HIV infections from new ones – acquired in the last half-year. Source:s (a) Rehle T, Shisana O, Pillay V, et al. National HIV incidence measures – new insights into the South African Epidemic. S Afr Med J 2007: 97: 194-199. Available at: http://www.samj.org.za/index.php/samj/article/view/777/247 (accessed 11 January 2012). (b) Shisana O, Rehle T, Simbayi L, et al, eds. South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey, 2005. Cape Town: Human Sciences Research Council, 2005. Available at:  http://www.hsrc.ac.za/en/research-outputs/view/2093 (accessed 15 October 2018).

1999-2003: Beginning in 1999, several doctors at Stellenbosch University and Tygerberg Children’s Hospital near Cape Town began to record cases of HIV-infected children with HIV-negative mothers. As of 2003, their registry included 14 HIV-positive children with HIV-negative mothers and no sexual exposures. These 14 children had been diagnosed with HIV at ages 3 months to 10 years. Thirteen had one or more previous hospital admissions during which 12 had intravenous catheters, 6 had been in intensive care, and 3 had surgeries. Source: Heimstra R, Rabie H, Schaaf HS, et al. Unexplained HIV-1 infection in children – documenting cases and assessing possible risk factors. S Afr Med J 2004; 94: 188-193. Available at: http://www.samj.org.za/index.php/samj/article/view/2531/1790 (accessed 15 October 2018).

2002: The Sowetan newspaper, 9 January 2003, reported an HIV-positive child with HIV-negative parents. The child tested HIV-positive at age 17 months in 2002. The child had not received any blood transfusions. Source: Mabena K. HIV baby: we ask medical experts. The Sowetan, 9 January 2003.

Unexpected HIV in adults and adolescents:

2014: During 2010-14, the African Health Research Institute collected and sequenced HIV (determined the order of each HIV’s constituent molecules) from 1,376 adults in mKhanyakude District, KwaZulu-Natal. After sequencing, the Institute found a cluster of 63 very similar HIV sequences, suggesting linked infections acquired in 2013-2014. Because sexual transmission is too slow to create such a large cluster in such a short time, the cluster suggests bloodborne transmission. Because persons contributing HIV to the cluster are distributed across the district with a concentration in mTubabtuba town,  one possible source of transmission is a health facility in the town. Because the town is on the eastern edge of the study area, and because the study sequenced HIV from circa 15% of infected adults in the study area, the cluster would likely include hundreds of HIV of new infections acquired during 2013-14 if sequencing had included all infected adults in and around mTubatuba town. As of October 2018, there is no indication the South African government is investigating this evidence of a likely nosocomial disaster. Source: See especially slide 10 in: Coltart C, Shahmanesh M, Hue S, et al. Ongoing HIV micro-epidemics in rural South Africa: the need for flexible interventions. Conference on Retroviruses and Opportunistic Infections, 4-7 March 2018. Available at: http://www.croiwebcasts.org/console/player/37090?mediaType=slideVideo&&crd_fl=0&ssmsrq=1522772955419&ctms=5000&csmsrq=5001(accessed 4 April 2018).

2012: Unexpected HIV in high school students: A survey among students 5 high schools in Umgungundlovu District of KwaZulu-Natal tested 3,241 young men and women aged 12 and up, with 7% aged more than 20 years. The survey found 142 HIV-positive students: 21 (55%) of 38 HIV-positive boys reported being virgins; 56 (54%) of 104 HIV-positive girls reported being virgins. Source: Kharsany ABM, Buthelezi TJ, Frohlich JA, et al. HIV infection in high school students in rural South Africa: role of transmissions among students. AIDS Res Hum Retroviruses 2014; 30: 956-965. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179919/ (accessed 13 February 2018).

2005: In a 2005 random sample national survey, virgin adults got HIV at the rate of 1.4% per year; adults who were sexually active in the last year got HIV at the rate of 2.4% per year; similarly, non-virgin adults who had not been sexually active in the last year got HIV at the same rate, 2.4% per year. The survey used the BED test to distinguish old HIV infections from new ones (ie, acquired in the last half-year). Sources: (a) Rehle T, Shisana O, Pillay V, et al. National HIV incidence measures – new insights into the South African Epidemic. S Afr Med J 2007: 97: 194-199. Available at: http://www.samj.org.za/index.php/samj/article/view/777/247 (accessed 11 January 2012). (b) Shisana O, Rehle T, Simbayi L, et al, eds. South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey, 2005. Cape Town: Human Sciences Research Council, 2005. Available at:  http://www.hsrc.ac.za/en/research-outputs/view/2093 (accessed 15 October 2018).

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