Clinical predictors of HIV-1 infection among preschool children in Dar es Salaam, Tanzania.
Seroprevalence of HIV-1 infection was determined in children aged between eighteen months and five years, attending maternal and child health (MCH) clinics in Dar es Salaam, Tanzania. A total of 889 children were eligible for the study, however seven children could not be enrolled because their mothers/guardians absconded and blood could not be drawn from 21 children due to refusal of mothers/guardians and from another 12 children due to technical reasons. Therefore, the participation rate was 95.5%. Of the 849 children screened, 14 (1.65%) were found to have IgG anti HIV-1 antibodies in their sera. The main clinical features found in children with symptomatic HIV-1 disease were weight loss, generalized lymphadenopathy, recurrent fevers, and prolonged diarrhoea. The utility of clinical features suggestive of HIV-1 infection (according to CDC classification) in identifying HIV-1 infection in children was evaluated and found to have high sensitivity (100%), specificity (96.9%) and negative predictive value (100%), but a low positive predictive value (35%). Marked variations in progression to symptomatic phase were noted, whereby some relatively young children had progressed to symptomatic phase (CDC class P-2A), while some older children were still in the asymptomatic stage (CDC class P-1 C). None of the symptomatic HIV-1 infected children presented with neurological disease, severe opportunistic infections, or malignancies. Although reduced mid-upper arm circumference and weight-for-age were associated with HIV seropositivity, these clinical parameters had low positive predictive values compared to the CDC classification.
Matee
M I
MI
Department of Microbiology and Immunology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
Lyamuya
E F
EF
Simon
E E
EE
Mwinula
J H
JH
Mbena
E C
EC
Samaranayake
L P
LP
Scheutz
F F
FF
D002675:Child, Preschool; D005260:Female; D006679:HIV Seropositivity / Q000145:classification / Q000150:complications / Q000453:epidemiology*; D015528:HIV Seroprevalence; D015497:HIV-1; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016036:Seroepidemiologic Studies; D013636:Tanzania / Q000453:epidemiology