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South Africa: cases and investigations

Unexpected HIV infections in children, 1999-2003: Beginning in 1999, several doctors at Stellenbosch University and Tygerberg Children’s Hospital near Cape Town began to record cases of HIV-negative 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 HIV-positive at ages 3 months to 10 years. Thirteen had one or more previous hospital admissions during which 12 had been fitted with 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://blues.sabinet.co.za/WebZ/Authorize?sessionid=0:autho=pubmed:password=pubmed2004&/AdvancedQuery?&format=F&next=images/ejour/m_samj/m_samj_v94_n3_a18.pdf (accessed 8 January 2012).

Unexpected HIV infections in children, 2002: A newspaper 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: Khethiwe Mabena. HIV baby: we ask medical experts. The Sowetan, 9 January 2003.

Unexpected HIV infections in children, 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: Karyn Maughan. Patients demand answers to HIV puzzle. Cape Times 27 August 2007.

Unexpected HIV infections in adults and children, 2005: In a 2005 random sample national survey: virgin adults got new HIV infections 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. In the same study, 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: 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). 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.hsrcpress.ac.za/product.php?productid=2134 (accessed 11 January 2012).

Unexpected infections in children, 2004-10:  After reporting 14 children with unexpected HIV infections in 2004 (see above), 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: http://pag.ias2011.org/EPosterHandler.axd?aid=2125.

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