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Acquired immunodeficiency syndrome (AIDS) in multitransfused children with thalassemia
1Department of Pediatrics, Charak Palika Hospital, Moti Bogh, New Delhi, India.
Insights
This study screened 203 children with thalassemia for human immunodeficiency virus (HIV). Eighteen children (8.9%) tested positive for HIV, with six diagnosed with acquired immunodeficiency syndrome (AIDS).
Area of Science:
- Pediatric Immunology
- Infectious Diseases
- Hematology
Background:
- Thalassemia is a common inherited blood disorder requiring frequent transfusions.
- Multi-transfused patients are at increased risk of transfusion-transmitted infections, including HIV.
- The prevalence and immunological impact of HIV in pediatric thalassemia patients in India were previously undocumented.
Purpose of the Study:
- To determine the prevalence of HIV infection in multi-transfused children with thalassemia in New Delhi.
- To conduct a detailed immunological evaluation of HIV-positive pediatric thalassemia patients.
- To compare the immunological status of HIV-positive and HIV-negative children with thalassemia.
Main Methods:
- Screening for HIV antibodies using ELISA and confirmation by Western Blot in 203 multi-transfused pediatric thalassemia patients.
- Immunological workup including absolute lymphocyte counts (ALC), CD4+ and CD8+ cell counts and ratios, immunoglobulin levels (IgG, IgM, IgA), and delayed cutaneous hypersensitivity (DCH) tests.
- Classification of HIV-positive children based on WHO clinical criteria for AIDS and CDC criteria for immune status.
Main Results:
- Eighteen out of 203 (8.9%) children with thalassemia were HIV positive.
- Six HIV-positive children met the WHO criteria for clinical AIDS.
- Immunological analysis revealed varying degrees of immune dysfunction in HIV-positive children, categorized using CDC criteria (P1A, P1B, P2A, P2C, P2D1, P2D2).
Conclusions:
- HIV infection is a significant concern in multi-transfused pediatric thalassemia patients in India.
- Immunological assessment is crucial for managing HIV-infected children with thalassemia.
- This study reports the first cases of pediatric AIDS in India among thalassemia patients.
Abstract:
Two hundred and three multi-transfused children with thalassemia attending the Thalassemia Clinic of the Charak Palika Hospital, New Delhi were screened for human immunodeficiency virus (HIV) antibodies by ELISA and all positive cases were confirmed by Western Blot. Of the 203 children screened, 18 (8.9%) were HIV positive, and in these children a detailed immunological work up was done and compared to 18 age-matched HIV negative thalassemics as controls. The tests included absolute lymphocyte counts (ALC), absolute and percentages of CD4+ and CD8+ cells and their ratios (CD4/CD8), immunoglobulin levels (IgG, IgM and IgA) and delayed cutaneous hypersensitivity (DCH) test by Multitest CMI in all the cases and the controls. Of the 18 HIV positive children, 6 were diagnosed to have clinical AIDS as per the WHO criteria. After immunological testing, the children were further classified according to the CDC criteria. By these criteria, 11 children were classified as P1 A (asymptomatic infection, normal immune function), 1 child as P1 B (asymptomatic infection, abnormal immune function), 2 children as P2 A (symptomatic infection with non-specific findings), 1 child as P2 C (lymphocytic interstitial pneumonitis), 1 child as P2 D1 (Pneumocystis carinii pneumonia) and 2 children as P2 D2 (symptomatic infection with infections). In this paper, the clinical features of the children with AIDS is described, and the immunologic functions of these children are compared with the HIV positive asymptomatic children and with controls. These are the first cases of AIDS in the pediatric age group from India.