Undiagnosed AIDS in a 13-year-old boy in rural Gabon.

Introduction: To date, 38.4 million people live with the Human Immunodeficiency virus (HIV) amongst whom 1.7 million are children below fourteen years of age. The highest burden of HIV is in sub-Saharan Africa. Children living with HIV acquired the infection mostly by mother-to-child transmission (MTCT), however the diagnosis is often delayed.In malaria-endemic countries, fever is one of the most frequent symptoms for seeking medical care and it is often primarily suspected as the onset of malaria or respiratory bacterial infections. Here, we report a case of late-onset undiagnosed AIDS in a 13-year-old boy living in rural Gabon in the Gabonese tropical rainforest in the province of Ngounié.

Case: A 13-year-old orphan child presented at our routine consultation for fever screening at the Institut de Santé de Sindara (ISSA) in 2021 due to remittent fever episodes, paleness, chronic fatigue and cough. His medical history documented repeated consultations and hospitalisations over the past years, establishing various diagnoses and treatments without significantly improving his condition. Serologic testing established the diagnosis of HIV-1 infection, classifying it as CDC stage 3 AIDS. Given the family history, late-onset symptomatic HIV infection 13 years after mother-to-child transmission was the most likely transmission mode.

Discussion: HIV infection may occur in older children and young adolescents and should be considered as an important differential diagnosis of reappearing fevers in regions of malaria transmission. Early diagnosis of HIV, particularly in children and adolescents, improves health outcomes. highlighting the need for HIV testing in children and adolescents.