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Updated: Aug 19, 2026
Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
CDC-defined diseases and opportunistic infections in Jamaican children with HIV/AIDS
R Pierre1, J C Steel-Duncan, T Evans-Gilbert
1The University of the West Indies, Kingston, Jamaica.
Insights
This study tracked 110 children with HIV/AIDS in Jamaica, finding that severe symptoms and opportunistic infections were common in this ARV-naive population. Findings highlight the need for improved pediatric HIV management and access to antiretroviral therapy.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Virology
- Public Health
Background:
- Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) continue to pose significant health challenges globally, particularly in developing nations.
- Paediatric HIV/AIDS requires specific management strategies due to the unique clinical presentations and disease progression in children.
- Understanding the natural history of pediatric HIV/AIDS in populations with limited access to antiretroviral therapy (ART) is crucial for effective public health interventions.
Purpose of the Study:
- To document the frequency of Centers for Disease Control and Prevention (CDC)-defined clinical conditions in children with HIV/AIDS.
- To identify common opportunistic infections and co-infections in this pediatric cohort.
- To characterize the clinical and pathological features of HIV/AIDS in children within a developing country context.
Main Methods:
- A prospective, observational study was conducted involving 110 HIV-infected children.
- Participants were followed in multicentre ambulatory clinics in Jamaica from September 1, 2002, to August 31, 2003.
- Children's clinico-pathologic characteristics were assessed using the CDC criteria for HIV/AIDS staging.
Main Results:
- The median age of the children was 6.0 years, with 88.0% infected via mother-to-child transmission and only 4% receiving antiretroviral prophylaxis.
- A significant proportion of children presented with severe symptoms (CDC Category C: 37.3%), with common conditions including wasting, encephalopathy, and serious bacterial infections.
- Pulmonary tuberculosis and Pneumocystis jirovecii pneumonia were the most frequent opportunistic infections; Streptococcus pneumoniae and Escherichia coli were common bacterial pathogens.
Conclusions:
- This study provides essential data on the natural history of pediatric HIV/AIDS in an antiretroviral (ARV)-naive population from a developing country.
- The findings underscore the need for enhanced training in pediatric HIV management.
- The study supports the goal of improving access to antiretroviral agents and implementing clinical trials in the Caribbean region.
Objective:
To document the frequency of Centers for Disease Control and Prevention (CDC)-defined clinical conditions, opportunistic and co-infections among children with HIV/AIDS.
Methods:
This prospective, observational study reports the findings of 110 HIV-infected children followed in multicentre ambulatory clinics during September 1, 2002, to August 31, 2003, from the 239 children enrolled in the Kingston Paediatric and Perinatal HIV/AIDS Programme, Jamaica. We describe the clinico-pathologic characteristics of these children with HIV/AIDS, using the CDC criteria.
Results:
The client distribution by clinic site was as follows: the University Hospital of the West Indies, 71 (64.6%), Bustamante Hospital for Children, 23 (20.9%), Comprehensive Health Centre 13 (11.8/%) and Spanish Town Hospital, 3 (2.7%). The median age of the 110 children with HIV/AIDS was 6.0 years (range 0.9-17.5). Mode of transmission was primarily mother-to-child (88.0%) and only 4% maternal/infant pairs received antiretroviralprophylaxis. Grouped by CDC category: 17 (15.4%) were asymptomatic (N), 22 (20.0%) mildly symptomatic (A), 30 (27.3%) moderately symptomatic (B) and 41 (37.3%) severely symptomatic (C). The most common CDC-defining symptoms were lymphadenopathy (12, 42.8%) and asymptomatic (6, 21.4%) in category N; lymphadenopathy (30, 29.7%), dermatitis (20, 19.8%) and persistent or recurrent upper respiratory tract infections (20, 19.8%) in category A; bacterial sepsis (18, 34.6%) and recurrent diarrhoea (11, 21.2%) in category B; and wasting (28, 30.0%), encephalopathy (26, 27.9%), and serious bacterial infections (15, 16.1%) in category C; Pulmonary tuberculosis (7, 7.5%) and Pneumocystis (jiroveci) carinii pneumonia; (5, 5.4%) were the most frequent opportunistic infections. Streptococcus pneumoniae (10, 30.3%) was the most common invasive bacterial pathogen causing sepsis and Escherichia coli (14, 34.2%) was the most common bacterial pathogen causing urinary tract infections, among the cohort. Thirty-three per cent commenced antiretroviral drugs (ARVs). There were 57 hospitalizations and five deaths.
Conclusions:
The study is an important step toward documentation of the natural history of paediatric HIV/AIDS in a primarily ARV-naive population from a developing country. It promotes training in paediatric HIV management as we move toward affordable access to antiretroviral agents in the wider Caribbean and the implementation of clinical trials.
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