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HIV infection and severe malnutrition: a clinical and epidemiological study in Burkina Faso
1Groupe d'Etudes Epidémiologiques et Prophylactiques (GEEP), Villeneuve St Georges, France.
Insights
In severely malnourished children in Burkina Faso, a specific clinical profile including marasmus, adenopathy, and oral candidiasis indicates Human Immunodeficiency Virus (HIV) infection. HIV-positive children face a poor prognosis, highlighting the need for early detection and intervention.
Area of Science:
- Pediatric Infectious Diseases
- Nutritional Immunology
- Global Health
Background:
- Severe malnutrition in children is a significant global health challenge, particularly in resource-limited settings.
- Human Immunodeficiency Virus (HIV) infection can exacerbate malnutrition and complicate clinical presentation in pediatric populations.
- Defining specific clinical indicators for HIV in malnourished children is crucial for timely diagnosis and management.
Purpose of the Study:
- To establish a clinical profile that is indicative of HIV infection among severely malnourished children in Burkina Faso.
- To identify key symptoms and clinical signs associated with HIV in this vulnerable pediatric population.
Main Methods:
- A cohort of 433 severely malnourished children (average age, 19 months) was recruited from Sanou Souro National Hospital, Burkina Faso.
- Clinical data, including malnutrition type, presence of specific symptoms (adenopathy, oral candidiasis, skin disorders, hepatomegaly), and HIV status, were collected.
- Statistical analyses, including discriminant and multivariate analyses, were employed to identify significant indicators of HIV infection.
Main Results:
- The prevalence of HIV infection in children over 12 months was 13.8%, predominantly HIV-1.
- Marasmus was the most frequent malnutrition type associated with HIV (P < 0.001), with HIV exacerbating its severity.
- Adenopathy (P < 0.0001), oral candidiasis (P < 0.0006), skin disorders (P < 0.01), and hepatomegaly (P = 0.01) were significantly linked to HIV infection. A clinical profile of marasmus, adenopathy, and oral candidiasis showed 82% specificity for HIV infection.
Conclusions:
- Severely malnourished children with HIV exhibit a distinct clinical profile, including a high rate of horizontal transmission and a poor prognosis.
- The presence of marasmus, adenopathy, and oral candidiasis serves as a strong indicator for HIV infection in this population.
- Early identification and intervention are critical due to the significantly worse clinical outcomes observed in HIV-positive malnourished children.
Objective:
To define a clinical profile indicative of HIV infection in a population of severely malnourished children in Burkina Faso. A total of 433 children (average age, 19 months) were recruited at the Sanou Souro National Hospital, Bobo Dioulasso, Burkina Faso.
Results:
Sixty-three per cent presented with marasmus, 13% with kwashiorkor and 24% with both forms of malnutrition. The prevalence of HIV infection in children aged over 12 months was 13.8%, with a marked predominance of HIV-1 (95.8%). Mother-to-child transmission was proven in 77% of the cases; in 10% of the observed paediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV (P < 0.001); its severity was exacerbated by HIV infection. Adenopathy (P < 0.0001), oral candidiasis (P < 0.0006), skin disorders (P < 0.01) and hepatomegaly (P = 0.01) appeared to be significantly related to HIV infection. Discriminant analysis revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis revealed that a clinical profile of marasmus, adenopathies and oral candidiasis (specificity, 82%) was indicative of HIV infection in this population. The short-term clinical prognosis was poor and usually led to the death of the child when seropositive (P < 0.001).
Conclusions:
Among children exhibiting severe malnutrition, HIV-positive children are distinguished by a high horizontal transmission rate, a high specific clinical profile and a very poor prognosis.