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The changing profile of paediatric HIV infection: An experience from the Middle East
Ali Al Sawai1, Ali Elgalib2, Badria Al Waili3
1Child Health Department, Royal Hospital, Ministry of Health, Muscat, Oman.
Insights
The number of pediatric HIV infections in Oman has significantly decreased following the implementation of the prevention of mother-to-child transmission (PMTCT) program. Children diagnosed after 2009 showed more asymptomatic infections and better clinical outcomes.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Public health
Background:
- HIV infection in children remains a global health concern.
- Mother-to-child transmission is a primary route of pediatric HIV infection.
- Effective prevention strategies are crucial for reducing pediatric HIV incidence.
Purpose of the Study:
- To evaluate the clinical and epidemiological characteristics of HIV-infected children in Oman.
- To assess the impact of the prevention of mother-to-child transmission (PMTCT) program on pediatric HIV cases.
- To compare outcomes in children diagnosed before and after PMTCT program implementation.
Main Methods:
- Retrospective review of pediatric HIV cases at a national unit (1992-2015).
- Analysis of demographic data, CD4 counts, and viral load at diagnosis and during treatment.
- Comparison of clinical presentation and outcomes based on diagnosis year (pre- and post-2009).
Main Results:
- 91 HIV-infected children were identified; 65% were ≤5 years old at diagnosis.
- Incidence peaked in 2010, with an average of 5.7 cases per million children.
- Children diagnosed after 2009 were more often asymptomatic (59.1% vs 23.5%) and had better clinical outcomes (86.4% vs 42.6%).
Conclusions:
- The PMTCT program has led to a substantial reduction in pediatric HIV infections in Oman.
- Later diagnosis (post-2009) is associated with improved clinical status and outcomes.
- Continued efforts in PMTCT are vital for further reducing the burden of pediatric HIV.
Objective:
To describe the clinical and epidemiological profiles of HIV-infected Omani children before and after the implementation of the prevention of mother-to-child transmission of HIV (PMTCT) programme.
Methods:
A retrospective review of HIV-infected children seen at a national paediatric HIV unit between 1992 and 2015 was performed.
Results:
Ninety-one HIV-infected children were identified; 59 (65%) were ≤5 years of age at diagnosis, with 28 (47.5%) of these being <1 year old. The average annual incidence of infection per million children (≤14 years old) was 5.7, and the highest (11.6) was in 2010. At diagnosis, 48 (60%) patients had a CD4 count of ˂200cells/mm3. The median HIV viral load was 81600copies/ml at diagnosis and 5911copies/ml at 12 months after HIV treatment (p=0.015). The median CD4 count was 586cells/mm3 at diagnosis and 800cells/mm3 at 12 months after therapy (p=0.004). Compared to those diagnosed before 2009 (n=68), HIV-infected children diagnosed after 2009 (n=22) were more likely to be asymptomatic at the time of HIV diagnosis (23.5% (16/68) vs. 59.1% (13/22); p=0.002) and to have a favourable clinical outcome (42.6% (29/68) vs. 86.4% (19/22); p<0001).
Conclusions:
The number of HIV-infected children in Oman has decreased substantially since the introduction of the PMTCT programme. Furthermore, the HIV-infected children diagnosed after 2009 had higher proportions of asymptomatic HIV infections at diagnosis and favourable clinical outcomes, in comparison to those diagnosed before 2009.
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