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Paediatric HIV infection in a rural South African district hospital
S Yeung1, D Wilkinson, S Escott
1Hlabisa Hospital, South Africa.
Insights
Paediatric HIV infection was prevalent in rural South Africa, affecting 26% of children. HIV-positive children experienced more severe malnutrition and higher mortality rates.
Area of Science:
- Paediatrics
- Infectious Diseases
- Public Health
Background:
- Human Immunodeficiency Virus (HIV) infection presents unique challenges in paediatric populations, particularly in resource-limited settings.
- Understanding the prevalence, clinical manifestations, and outcomes of paediatric HIV is crucial for effective healthcare planning and intervention.
Purpose of the Study:
- To determine the prevalence, clinical spectrum, and outcomes of paediatric HIV infection.
- To analyze the clinical presentation and treatment response in HIV-infected children admitted to a rural South African hospital.
Main Methods:
- A study of 281 consecutive paediatric admissions in rural South Africa (October 1996 - January 1997).
- HIV infection diagnosis utilized age-specific criteria including ELISA, IgG3, p24 antigen, and PCR.
- Comparison of clinical features, previous admissions, malnutrition status, presenting illnesses, antibiotic response, and mortality between HIV-infected and uninfected children.
Main Results:
- Overall paediatric HIV prevalence was 26% (72 children), with at least 25% prevalence in 1-5 year olds.
- HIV-infected children had higher rates of previous admissions (46% vs. 23%) and severe malnutrition (52% vs. 17%).
- While diarrhoeal disease was common in both groups, HIV-infected children showed poorer response to antibiotics (56% vs. 73%) and significantly higher mortality (21% vs. 7%).
Conclusions:
- Paediatric HIV infection in this setting presents with common disease syndromes but with increased frequency and worse outcomes.
- The high burden of paediatric HIV infection poses a significant challenge to local health resources.
- Early identification and management strategies are critical for improving outcomes in HIV-affected children in similar settings.
Abstract:
The objective of this study was to determine the prevalence, clinical spectrum, and outcome of paediatric HIV infection in 281 consecutive children admitted to hospital in rural South Africa between October 1996 and January 1997. HIV infection was defined as two positive ELISAs in those aged > 12 months; a positive ELISA plus a positive IgG3 in those aged 6-12 months; and a positive ELISA plus positive p24 antigen or PCR in those aged 0-5 months. In all, 72 (26 per cent) children were HIV infected. Age-specific HIV prevalence was at least 25 per cent in all 1-5 year age groups. HIV-infected children were more likely to have been previously admitted (46 per cent vs. 23 per cent; p = 0.0002), and were more likely to have severe malnutrition (52 per cent vs. 17 per cent; p < 0.0001). Both HIV-infected and HIV-uninfected most frequently presented with diarrhoeal disease (51 per cent vs. 32 per cent), acute respiratory infection (13 per cent vs. 23 per cent), and malnutrition (18 per cent vs. 11 per cent). Satisfactory response to antibiotic therapy was less likely among the HIV-infected (56 per cent vs. 73 per cent; p = 0.02), and mortality was higher among the HIV-infected (21 per cent vs. 7 per cent; p = 0.005). It is concluded that HIV-infected children present with disease syndromes common to this setting, but do so more frequently and with worse outcome than their uninfected counterparts. The high burden of paediatric HIV disease in this setting poses a substantial challenge for health resources.