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We highly appreciate the valuable comments by Lyall and colleagues concerning the importance of congenital HIV as a differential diagnosis in any clinical setting where immunodeficiency is considered. Our paper is focusing on the concept of normality in terms of numbers and severity of infections, and clinical clues to primary immunodeficiency syndromes. Although secondary immunodeficiencies were not within the scope of our paper, we agree that it would have been a great opportunity to raise the awareness regarding the clinical presentation of HIV infection in children.
Per Wekell, Olof Hertting, Daniel Holmgren, Anders Fasth
We read with interest the extensive review of clinical presentations of immunodeficiency in childhood in the Archives Education & Practice October edition, we enjoyed the way that clinical scenarios were presented, most useful for the front line paediatrician.
However, we were surprised and disappointed that by far the most common single cause of paediatric immunodeficiency and the most important differential diagnosis, congenital HIV infection, was not mentioned at all in the piece.
This seemed a significant oversight as in the UK, annually there are still 20-30 children per year diagnosed with HIV, either born here, or new arrivals to the country (https://www.ucl.ac.uk/nshpc/) . This is an important differential diagnosis for the infant presenting in respiratory failure with SCID, or the child with invasive pneumococcal disease, or recurrent shingles, or recurrent bacterial infections, or lymphopaenia. More importantly, this is now a highly treatable condition, and early treatment is correlated with the best long term outcomes.
We hope that your readers may be reminded of this, and will rule out HIV infection, prior to embarking on costly and complex immune investigations.