HIV infection and severe malnutrition: a clinical and epidemiological study in Burkina Faso.
OBJECTIVE
To define a clinical profile indicative of HIV infection in a population of severely malnourished children in Burkina Faso. A total of 433 children (average age, 19 months) were recruited at the Sanou Souro National Hospital, Bobo Dioulasso, Burkina Faso.


RESULTS
Sixty-three per cent presented with marasmus, 13% with kwashiorkor and 24% with both forms of malnutrition. The prevalence of HIV infection in children aged over 12 months was 13.8%, with a marked predominance of HIV-1 (95.8%). Mother-to-child transmission was proven in 77% of the cases; in 10% of the observed paediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV (P < 0.001); its severity was exacerbated by HIV infection. Adenopathy (P < 0.0001), oral candidiasis (P < 0.0006), skin disorders (P < 0.01) and hepatomegaly (P = 0.01) appeared to be significantly related to HIV infection. Discriminant analysis revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis revealed that a clinical profile of marasmus, adenopathies and oral candidiasis (specificity, 82%) was indicative of HIV infection in this population. The short-term clinical prognosis was poor and usually led to the death of the child when seropositive (P < 0.001).


CONCLUSIONS
Among children exhibiting severe malnutrition, HIV-positive children are distinguished by a high horizontal transmission rate, a high specific clinical profile and a very poor prognosis.
Prazuck
T
T
Groupe d'Etudes Epidémiologiques et Prophylactiques (GEEP), Villeneuve St Georges, France.
Tall
F
F
Nacro
B
B
Rochereau
A
A
Traore
A
A
Sanou
T
T
Malkin
J E
JE
Apaire-Marchais
V
V
Masson
D
D
Dublanchet
A
A
D002050:Burkina Faso / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007223:Infant; D007732:Kwashiorkor / Q000150:complications; D008297:Male; D015999:Multivariate Analysis; D009748:Nutrition Disorders / Q000150:complications*; D011379:Prognosis; D011502:Protein-Energy Malnutrition / Q000150:complications