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.
Department of Microbiology and Immunology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
M I
MI
Matee
E F
EF
Lyamuya
E E
EE
Simon
J H
JH
Mwinula
E C
EC
Mbena
L P
LP
Samaranayake
F F
FF
Scheutz
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