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Otorrhoea is a marker for symptomatic disease in HIV-infected children
J Karpakis1, H Rabie, J Howard
1Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital and Stellenbosch University, W Cape.
Insights
Chronic otorrhoea is common in children with human immunodeficiency virus (HIV). This condition indicates symptomatic disease and lower CD4 counts, highlighting its importance in clinical assessments.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Chronic otorrhoea is a frequent complication in children with human immunodeficiency virus (HIV) infection.
- Limited data exist regarding the incidence and severity of otorrhoea in this pediatric population.
Purpose of the Study:
- To determine the prevalence of otorrhoea among children attending a human immunodeficiency virus (HIV) clinic.
- To analyze the relationship between otorrhoea, disease stage, and immune status in HIV-infected children.
Main Methods:
- A retrospective chart review of 326 HIV-infected children from February 1997 to December 2001.
- Otorrhoea was categorized as mild (less than 1 month) or severe (more than 1 month or recurrent episodes).
- Clinical and immune stages (Centers for Disease Control classification) and CD4 percentages were recorded.
Main Results:
- Otorrhoea was present in 104 (32%) children, with 13.8% experiencing mild and 18.1% severe cases.
- Children with otorrhoea had significantly lower median CD4 percentages (17.5%) compared to those without (21%).
- Advanced disease stages (B or C) and lower immune classifications were associated with a higher likelihood of severe otorrhoea.
Conclusions:
- Otorrhoea significantly contributes to the morbidity experienced by children with HIV.
- The presence of otorrhoea serves as a clinical marker for symptomatic human immunodeficiency virus (HIV) disease and CD4 cell depletion.
- Otorrhoea should be considered in the clinical classification and management of HIV-infected children.
Background:
Chronic otorrhoea occurs commonly in HIV-infected children. However, there are few data on incidence and severity.
Objective:
To document the prevalence of otorrhoea in the clinic attendees.
Methods:
A retrospective chart review was done of all HIVI infected children seen at the Family Clinic for HIV from 1 February 1997 to 31 December 2001, a period preceding widespread availability of antiretrovirals. Otorrhoea was classified into two groups, viz. group 1 (mild): an episode lasting less than 1 month, and group 2 (severe): an episode lasting more than 1 month or more than 1 episode of otorrhoea. The clinical and immune stages of the children were noted.
Results:
Of 326 children seen during the study period, 104 (32%) had otorrhoea. Forty-five (13.8%) had mild and 59 (18.1%) severe otorrhoea. Two hundred and eighty-eight (88.6%) had either Centers for Disease Control stage B or C disease. The median CD4 percentage in children with otorrhoea was 17.5% (8.3-23%) versus 21% (14-28%) in those without otorrhoea (p=0.004). The odds ratio (OR) of children in stage B or C not having severe otorrhoea was 0.1 (0.01 - 0.72, p = 0.013). The OR for immune class 2 or 3 without severe otorrhoea was 0.39 (0.18 - 0.85, p = 0.021).
Conclusions:
Otorrhoea contributes to the morbidity of HIV infection in children. It is a marker for symptomatic disease and CD4 depletion and should be included in clinical classifications.
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