title: Validation of 2006 WHO prediction scores for true HIV infection in children less than 18 months with a positive serological HIV test.
abstract: BACKGROUND
  All infants born to HIV-positive mothers have maternal HIV antibodies, sometimes persistent for 18 months. When Polymerase Chain Reaction (PCR) is not available, August 2006 World Health Organization (WHO) recommendations suggest that clinical criteria may be used for starting antiretroviral treatment (ART) in HIV seropositive children <18 months. Predictors are at least two out of sepsis, severe pneumonia and thrush, or any stage 4 defining clinical finding according to the WHO staging system.
  
  
  RESULTS
  From January 2005 to October 2006, we conducted a prospective study on 236 hospitalized children <18 months old with a positive HIV serological test at the national reference hospital in Kigali. The following data were collected: PCR, clinical signs and CD4 cell count. Current proposed clinical criteria were present in 148 of 236 children (62.7%) and in 95 of 124 infected children, resulting in 76.6% sensitivity and 52.7% specificity. For 87 children (59.0%), clinical diagnosis was made based on severe unexplained malnutrition (stage 4 clinical WHO classification), of whom only 44 (50.5%) were PCR positive. Low CD4 count had a sensitivity of 55.6% and a specificity of 78.5%.
  
  
  CONCLUSIONS
  As PCR is not yet widely available, clinical diagnosis is often necessary, but these criteria have poor specificity and therefore have limited use for HIV diagnosis. Unexplained malnutrition is not clearly enough defined in WHO recommendations. Extra pulmonary tuberculosis (TB), almost impossible to prove in young children, may often be the cause of malnutrition, especially in HIV-affected families more often exposed to TB. Food supplementation and TB treatment should be initiated before starting ART in children who are staged based only on severe malnutrition.
authors.affiliation: Esther Project/Luxembourg (Lux-Development), Kigali, Rwanda. alexandrapeltier@hotmail.com
authors.forename: Cécile Alexandra
authors.initials: CA
authors.lastname: Peltier
authors.forename: Christine
authors.initials: C
authors.lastname: Omes
authors.forename: Patrick Cyaga
authors.initials: PC
authors.lastname: Ndimubanzi
authors.forename: Gilles François
authors.initials: GF
authors.lastname: Ndayisaba
authors.forename: Sara
authors.initials: S
authors.lastname: Stulac
authors.forename: Vic
authors.initials: V
authors.lastname: Arendt
authors.forename: Olivier
authors.initials: O
authors.lastname: Courteille
authors.forename: Narcisse
authors.initials: N
authors.lastname: Muganga
authors.forename: Kizito
authors.initials: K
authors.lastname: Kayumba
authors.forename: Jef
authors.initials: J
authors.lastname: Van den Ende
mesh_terms: D018791:CD4 Lymphocyte Count; D005260:Female; D015483:HIV Antibodies / Q000276:immunology; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology; D006679:HIV Seropositivity; D006801:Humans; D007223:Infant; D008297:Male; D012432:Rwanda; D014944:World Health Organization
chemical_list: D015483:HIV Antibodies