Profiles of HIV-infected anti-retroviral therapy naïve children from Mumbai, India.
BACKGROUND
This study aimed to investigate the demographic profiles of human immunodifficiency virus (HIV) infected anti-retroviral therapy (ART) naïve children in our hospital and their relations to the clinical, immunological and nutritional status.


METHODS
A cross-sectional study was conducted in an Integrated Counselling and Testing Center (ICTC) at a tertiary care hospital in Mumbai. ART naïve HIV positive children were enrolled in the study. The demographic profiles, clinical features, immunological (CD4%/CD4 count) and nutritional status of these children were recorded. The agreement between clinical, immunological and nutritional staging was determined using Cohen's kappa test.


RESULTS
In 192 HIV-infected ART naive children enrolled with a median age of 9 years (range 3 months-14 years), 97.4% acquired infection through vertical transmission. The most common clinical presentation was fever (39.6 %), followed by generalized lymphadenopathy (32.3%), cough (22.4%) and diarrhoea (9.9%). Tuberculosis was seen in 22.9% of the children. The agreement was fair between clinical and immunological staging, and slight between nutritional, immunological and clinical staging.


CONCLUSIONS
Perinatal transmission is the most common mode of acquiring HIV infection in children. The Prevention of Parent to Child Transmission (PPTCT) program should be strengthened for lowering the transmission rate by providing extended ART to mothers during pregnancy and breast-feeding. Tuberculosis remains a major concern in HIV-infected children. The poor correlation between WHO clinical and immunological staging emphasizes the importance of making CD4 facilities available in HIV prevalent areas. Malnutrition cannot be used as a surrogate marker for predicting stage or severity as it is common at all stages of HIV disease.
Department of Microbiology, 5th floor, Multi-Storey Building, Seth G. S. Medical College and K. E. M. Hospital, Parel, 400012, Mumbai, India. supriyaparanjpe@rediffmail.com.
Supriya Mayur
SM
Paranjpe
Department of Microbiology, 5th floor, Multi-Storey Building, Seth G. S. Medical College and K. E. M. Hospital, Parel, 400012, Mumbai, India.
Purva Pankaj
PP
Sarkate
Department of Microbiology, 5th floor, Multi-Storey Building, Seth G. S. Medical College and K. E. M. Hospital, Parel, 400012, Mumbai, India.
Nayana Avinash
NA
Ingole
Department of Microbiology, 5th floor, Multi-Storey Building, Seth G. S. Medical College and K. E. M. Hospital, Parel, 400012, Mumbai, India.
Shweta Sadanand
SS
Raut
Department of Microbiology, 5th floor, Multi-Storey Building, Seth G. S. Medical College and K. E. M. Hospital, Parel, 400012, Mumbai, India.
Preeti Rajeev
PR
Mehta
D000293:Adolescent; D017677:Age Distribution; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D015994:Incidence; D007194:India; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D062606:Tertiary Care Centers; D014505:Urban Population
D044966:Anti-Retroviral Agents
CD4 count; HIV; anti-retroviral therapy; clinical stage; nutritional status