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Clinical and epidemiological features of HIV-1 seropositive hospitalized Ethiopian children
Insights
Pediatric HIV-1 infection in Ethiopia presents with common childhood illnesses, not typical opportunistic infections. Early diagnosis and prevention strategies are crucial for combating the spread of HIV in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Human Immunodeficiency Virus type 1 (HIV-1) infection in children poses a significant global health challenge.
- Understanding the clinical presentation of pediatric HIV-1 in diverse settings is essential for timely diagnosis and management.
- Limited data existed on pediatric HIV-1 in Ethiopia during the study period.
Purpose of the Study:
- To describe the clinical characteristics and presentation of pediatric HIV-1 infection in Ethiopian children.
- To identify common symptoms and diagnoses associated with HIV-1 in this population.
- To inform prevention and control strategies for pediatric HIV-1 in Ethiopia.
Main Methods:
- Retrospective case series of eleven children diagnosed with HIV-1.
- Diagnosis confirmed using Enzyme-Linked Immunosorbent Assay (ELISA) and Western blot.
- Data collected on demographics, clinical signs, symptoms, and presumed transmission routes.
Main Results:
- The mean age of affected children was 2 years and 5 months, with a male predominance (7 boys, 4 girls).
- Common admitting diagnoses included pneumonia, gastroenteritis, marasmus, and disseminated tuberculosis.
- Symptoms like diarrhea, failure to thrive, fever, and cough were prevalent; opportunistic infections were notably absent.
- Encephalopathy was present in 5 patients; perinatal transmission was the presumed route in most cases.
Conclusions:
- Pediatric HIV-1 in Ethiopia presents atypically, mimicking common pediatric ailments rather than classic opportunistic infections.
- Clinical suspicion should be raised based on prevalent local pediatric diseases.
- Effective prevention requires targeting women of childbearing age, counseling, and robust blood product screening.
Abstract:
Eleven children were identified as being seropositive for HIV-1 at the Ethio-Swedish Children's Hospital, Addis Abeba, Ethiopia between January 1988 and September 1989. The diagnosis was confirmed by both ELISA and Western blot methods performed at the National Research Institute of Health, Special Laboratory for AIDS. The mean age was 2 years and 5 months, with a range of 1 week to 10 years. There were 7 boys and 4 girls. The most common admitting diagnoses were pneumonia (5), gastroenteritis (5), marasmus (5), disseminated tuberculosis (4), and abandonment (3). One patient had extensive facial molluscum contagiosum. Symptoms at admission or during hospitalization included diarrhoea (9), failure to thrive (8), fever (7), and cough (7). Physical findings included hepatosplenomegaly (5), lymphadenopathy (3), and oral candidiasis (2). No patient with an opportunistic infection or radiographic evidence of lymphocytic interstitial pneumonitis (LIP) was identified. Five patients were classified as marasmic and 4 as underweight. Evidence suggestive of encephalopathy (developmental delay and/or microcephaly) was present in 5 patients. The VDRL was non-reactive in the 5 patients in whom it was tested. Nine children were presumed to have acquired the infection by perinatal transmission, though the passive transfer of maternal antibodies or postnatally acquired infection could not be excluded. One child was thought to have acquired the infection by blood transfusion. Three children died during their hospital stay. Paediatric HIV infection exists in Ethiopia; however, these children do not present with characteristic opportunistic infections but with signs and symptoms reflecting the most common paediatric problems seen in the country. Prevention of HIV infection in children entails the prevention of infection in women of childbearing age, counselling of infected women, and effective screening of blood products.