Vertically transmitted HIV infection having first clinical manifestations at 13 y of age.

Untreated vertically transmitted human immunodeficiency virus (HIV) infection progresses rapidly with 50% mortality at 1 y and most of the remainder dying before 5 y of age. The authors present a case of a 13-y-old boy, a paternal orphan with vertically transmitted HIV infection, lost to follow up after diagnosis in infancy, surviving to date without any major illness or medical intervention, till the present episode of full blown AIDS. The boy presented with shock, pneumocystis jirovecii pneumonia (PJP), disseminated tuberculosis, Herpes Simplex Type 1 (HSV-1) infection, anemia, malnutrition and oral candidiasis. Later he developed systemic candidiasis, transient renal and respiratory failure. CD4 counts were 41 cells/μl. He was managed with sulphamethoxazole/trimethoprim (SXTM) combination, anti tubercular therapy, fluconazole, anti-retroviral therapy (ART) and supportive measures with full recovery at 2 mo. Thus, better ART during antenatal care and immediately after birth are likely to see more of such children survive to teenage and adulthood.