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Published on: June 11, 2011
Clinical profile of pediatric HIV infection from India
Shilpa R Shah1, Milind S Tullu, Jaishree R Kamat
1Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India.
Insights
Perinatal transmission is the primary route of pediatric HIV infection in India. Most affected children present with malnutrition and opportunistic infections like tuberculosis, leading to a significant mortality rate.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Epidemiology
- Public Health
Background:
- Understanding the clinical profile of pediatric Human Immunodeficiency Virus (HIV) infection is crucial for effective management.
- Limited data exists on the specific clinical manifestations and outcomes in Indian pediatric populations.
Purpose of the Study:
- To elucidate the clinical characteristics, common opportunistic infections, and outcomes of hospitalized pediatric patients with HIV.
- To identify the predominant modes of HIV transmission in children within the study cohort.
Main Methods:
- A prospective study was conducted from January 2000 to October 2001 in Mumbai, India.
- Enrolled 50 HIV-positive children (1 month to 12 years) using ELISA and DNA-PCR confirmation.
- Collected demographic, clinical, investigational, and outcome data.
Main Results:
- Perinatal transmission (42/50) was the most common route, followed by blood transfusion (8/50).
- Symptomatic children frequently presented with protein-energy malnutrition (90%), prolonged fever (50%), and skin manifestations (79%).
- Common opportunistic infections included tuberculosis (19 cases) and candidiasis (6 cases); mortality was 14%.
Conclusions:
- Perinatal HIV transmission is the leading cause in Indian children.
- Protein-energy malnutrition and tuberculosis are highly prevalent among pediatric HIV cases.
- HIV-encephalopathy is associated with poor outcomes in this population.
Background:
Our aim was to study the clinical profile of pediatric patients admitted with HIV infection.
Methods:
The prospective study was conducted from January 2000 to October 2001 at a tertiary care referral teaching hospital in Mumbai, India. Admitted in-patients (aged 1 month to 12 years) detected to be HIV-positive (on triple ELISA test) were enrolled in the study. HIV status of patients < 18 months of age was confirmed by DNA-PCR testing. Demographic data, clinical features, investigations and outcome were recorded in a pre-designed proforma.
Results:
Fifty HIV-positive children (31 males and 19 females; M:F = 1.6:1) were enrolled. Thirty cases were completely immunized, 9 were partially immunized while 11 were not immunized. Forty-two were perinatally infected, while eight cases were infected via blood transfusion (patients with thalassemia major on chronic transfusion therapy). Clinical features at presentation in 42 symptomatic cases included protein-energy malnutrition (90%), fever > 1 month (50%), weight loss > 1 month (50%), persistent generalized lymphadenopathy (24%) and skin manifestations (79%). The gastrointestinal (62%) and respiratory (52%) were the most commonly involved organ systems. Opportunistic infections noted included tuberculosis (19 cases), candidiasis (6 cases), Pneumocystis carinii pneumonia (4 cases), herpes zoster (3 cases) and giardiasis (1 case). Six patients died (mortality, 14%).
Conclusions:
Perinatal transmission is the most common mode of acquiring HIV in the pediatric age group. Most patients have protein-energy malnutrition. Tuberculosis is common in HIV-infected Indian children. Patients with HIV-encephalopathy have a poor outcome.
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