title: HIV infection in severely malnourished children in Kumasi, Ghana: a cross-sectional prospective study.
abstract: BACKGROUND
  The Human Immunodeficiency Virus (HIV) epidemic has adversely affected the nutritional status and mortality of children in Africa. This study assessed the disease burden, predictive clinical features and outcomes for children with severe acute malnutrition (SAM) and concomitant HIV infection.
  
  
  METHODS
  This was a cross-sectional prospective study of children with SAM aged between 3 months and 13 years admitted to the nutritional rehabilitation unit (NRU) of Komfo Anokye Teaching Hospital. Socio-demographic, anthropometric and clinical data were documented and HIV serostatus established with 2 rapid HIV antibody tests and Enzyme-linked immunosorbent assay, if indicated. HIV viral polymerase chain reaction testing was not available at the time of the study. Logistic regression analyses were used to identify significant clinical predictors of HIV seropositivity.
  
  
  RESULTS
  Sixty-seven (27.2%, 95% CI = 21.8-33.3%) of the 246 study children had positive HIV antibody results. Uptake of provider-initiated HIV testing and counselling was 100%. Amongst children aged 18 months and over, the HIV seroprevalence was 28.3% (30/106). HIV seropositivity was strongly associated with prolonged fever, cough and diarrhoea; oral thrush, generalised lymphadenopathy and pulmonary tuberculosis (p value < 0.001 for all parameters). The presence of  ≥  3 of the first 5 aforementioned parameters was highly specific (98.3-100%) for HIV seropositivity in study children. HIV seropositivity was also significantly associated with cough, vomiting, lethargy/altered consciousness, skin rash and hepatomegaly (p value < 0.05 for all parameters). Overall mortality rate was 17.5%, with HIV seropositive children having a significantly higher mortality rate (37.8% versus 10.1%; p value < 0.001) and a lower rate of weight gain (2.4 g/kg/day versus 7.0 g/kg/day; p value < 0.001).
  
  
  CONCLUSIONS
  HIV testing was well accepted by parents/carers and should be offered in all NRUs. There was a high HIV seroprevalence among children with SAM and a significantly poorer outcome in mortality and weight gain. Some clinical features were identified to be predictive of HIV seropositivity and could be useful as indicators to prompt further investigation and/or referral in resource limited settings where HIV test kits are unavailable. This would aid in the early detection and comprehensive management of the HIV seropositive child with SAM.
authors.affiliation: Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana. sbasafoagyei@gmail.com.
authors.forename: Serwah Bonsu
authors.initials: SB
authors.lastname: Asafo-Agyei
authors.forename: Sampson
authors.initials: S
authors.lastname: Antwi
authors.forename: Samuel Blay
authors.initials: SB
authors.lastname: Nguah
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data; D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000293:Adolescent; D000465:Algorithms; D000886:Anthropometry; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D015528:HIV Seroprevalence; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000534:rehabilitation; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012959:Socioeconomic Factors; D016019:Survival Analysis; D063189:Symptom Assessment; D062606:Tertiary Care Centers; D014505:Urban Population / Q000706:statistics & numerical data