Le sida de l'enfant Africain

Abstract

It is estimated in the absence of reliable data that 200,000 children, 90% of them in Africa and the Caribbean, became infected with HIV through 2989. 1.5 million fertile-aged women were also infected. A 25% increase in mortality among children under 5 in Africa is 1 probable result. A doubling or tripling of mortality among adults will cause a fertility decline and an increase in infant mortality due to malnutrition. 200,000 children are expected to be orphaned by AIDS by 1992. 60-70% of seropositive African children are believed to have been infected by their mothers. Over half of infants born to mothers seropositive for HIV1 develop the disease. Reasons why vertical HIV1 transmission is apparently more likely than in Europe are not yet known. Vertical transmission of HIV2 is apparently much less likely. Contamination by blood transfusions is still very frequent. Although data are scarce, contamination through broken skin is known to occur, through use of infected syringes, during traditional scarification or circumcisions, during delivery in certain maternity centers when scarce tools are reused to cut the umbilical cord. There is some risk of contamination through mother's milk, but it is greatly exceeded by the benefits to infants of breastfeeding, especially in impoverished families. 10-30% of AIDS cases in children develop before 6 months and are manifested by polyadenopathic syndrome, hepatosplenomegalies, persistent and invasive esophageal and perhaps cutaneous candidiasis, prolonged or recurring fever, and failure to grow. Pulmonary complications are frequent. After 6 months, initial manifestations of the disease are more varied. Very often there is a severe and rapid decline in the general state of health, ending in marasmus with opportunistic infections. Tuberculosis is frequent. Anemia, bleeding problems, and cutaneous signs are common. Laboratory diagnoses are not available in most African health services. A clinical finding of 3 or 4 signs of AIDS in the absence of known cause of immunodeficiency is most often the basis for diagnosis of AIDS. A positive ELISA result in a child with strong clinical signs of AIDS may be considered sufficient evidence, but there are numerous potential causes of error. AIDS typically progresses very rapidly in African children, with early initial signs, frequent and severe infections, delays in diagnosis and treatment, and interactions with malnutrition. Children of seropositive mothers should be monitored carefully. Even if not infected at birth, they face grave risks when their mothers become ill. Seropositive children should receive all schedule vaccinations as long as they remain asymptomatic. Health care personnel should minimize blood transfusions, sterilize all materials, and inform the public about HIV infection and its prevention. Educational campaigns are still the only true means of combatting AIDS.