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AIDS--the Baragwanath experience. Part II. HIV infection in pregnancy and childhood
1Department of Paediatrics, Baragwanath Hospital, Johannesburg.
Insights
Perinatally acquired human immunodeficiency virus (HIV) infection in children leads to rapid disease progression and high mortality. Early symptoms include failure to thrive, enlarged lymph nodes, and liver enlargement, with cardiorespiratory issues being common.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Baragwanath Hospital observed 51 symptomatic children with perinatally acquired HIV by 1990.
- HIV infection in children acquired vertically presents a significant public health challenge.
Purpose of the Study:
- To describe the clinical characteristics and outcomes of children with perinatally acquired HIV.
- To assess the HIV seroprevalence trend in pregnant women in Soweto.
Main Methods:
- Retrospective case review of symptomatic children with perinatally acquired HIV.
- Analysis of HIV seroprevalence data from pregnant women attending Baragwanath Hospital and Soweto clinics from 1988 to 1990.
Main Results:
- Of 42 followed children, 35.7% died and 38.1% were lost to follow-up, indicating a high case fatality rate (35.7%-73.8%).
- Common initial symptoms included lymphadenopathy, failure to thrive, and hepatomegaly, often before 6 months of age.
- Cardiorespiratory symptoms, recurrent bacterial infections, and neurodevelopmental issues were prevalent. HIV seroprevalence in pregnant women was 0.82% by end of 1990, with a doubling time of 7-21 months.
Conclusions:
- Vertically acquired HIV infection progresses rapidly in children, with cardiorespiratory complications being a major concern.
- The high mortality and loss to follow-up underscore the severity of pediatric HIV. The increasing seroprevalence necessitates urgent public health interventions.
Abstract:
By the end of 1990, 51 symptomatic children with perinatally acquired HIV infection had been admitted to Baragwanath Hospital. Of 42 children who were followed up for at least 3 months, 15 (35.7%) died and 16 (38.1%) were lost to follow-up. The case fatality rate for these children lies between 35.7% and 73.8%. Most children became symptomatic before the age of 6 months and presenting features seen in over 70% of cases included lymphadenopathy, failure to thrive and hepatomegaly. Surviving children had recurrent admissions to hospital, predominantly for respiratory distress. Many had bacterial pneumonias. Cardiac involvement (cardiomyopathy and cor pulmonale), recurrent serious bacterial infections and neurodevelopmental abnormalities were common. Our experience confirms that vertically acquired HIV infection has a relatively short incubation period and progresses rapidly with cardiorespiratory symptoms predominating. Five HIV seroprevalence studies have been conducted in pregnant women attending Baragwanath Hospital and the Soweto clinics since 1988. The calculated doubling time is between 7 and 21 months. At the end of 1990 the HIV seroprevalence rate in pregnant women was 0.82% (95% confidence limits 0.44-1.19%).