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Disease in children infected with HIV in Abidjan, Côte d'Ivoire
S B Lucas1, C S Peacock, A Hounnou
1Department of Histopathology, University College London Medical School.
Insights
African children with HIV experience more overlapping diseases than adults, with higher rates of Pneumocystis pneumonia and measles, but less tuberculosis. This highlights unique pediatric HIV disease patterns.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Research
- Global Health
Background:
- Human Immunodeficiency Virus (HIV) infection presents distinct clinical manifestations in children compared to adults.
- Understanding the spectrum of diseases in HIV-infected African children is crucial for effective management and public health strategies.
Purpose of the Study:
- To document the range of diseases and causes of death in African children infected with HIV.
- To compare the disease profiles of HIV-positive and HIV-negative children in Abidjan, Côte d'Ivoire.
Main Methods:
- A necropsy-based study was conducted on consecutive HIV-positive and HIV-negative children (aged ≥1 month) at a major hospital in Abidjan.
- Disease prevalence and causes of death were pathologically confirmed.
- IgA western blots were used to validate routine HIV serology in children under two years.
Main Results:
- Respiratory tract infections were significantly more common in HIV-positive children (94%) than in HIV-negative children (68%).
- Pneumocystis carinii pneumonia occurred in 31% of HIV-positive children under 15 months, absent in controls.
- Measles was more prevalent in older HIV-positive children (19%) compared to HIV-negative children (4%).
Conclusions:
- HIV-infected African children exhibit a broader overlap of diseases with common childhood illnesses than observed in adults.
- Key differences include a high prevalence of Pneumocystis carinii pneumonia and lower rates of tuberculosis in HIV-positive children compared to adults.
- Measles, unlike malaria, was found to be associated with HIV infection in this pediatric cohort.
Objective:
To document the range of disease in African children infected with HIV.
Design:
Necropsy results in consecutive children aged 1 month or more who were HIV positive and in children who were HIV negative for comparison; IgA western blots on serum samples from children under 2 years of age who were positive for HIV-1 to test the validity of routine HIV serology.
Setting:
Largest hospital in Abidjan, Côte d'Ivoire.
Subjects:
78 children who were HIV positive and 77 children who were HIV negative on whom a necropsy was performed; their median ages at death were 18 and 21 months respectively. 36 HIV positive children and 29 HIV negative children were 1-14 months old; 42 HIV positive and 48 HIV negative children were > or = 15 months old.
Main Outcome Measures:
Cause of death and prevalence of diseases confirmed pathologically.
Results:
Respiratory tract infections were more common in HIV positive than in HIV negative children (73 (94%) v 52 (68%); P < 0.05), and were aetiologically heterogeneous. Pneumocystis carinii pneumonia was found in 11 out of 36 (31%) HIV positive children aged < 15 months, but in no HIV negative children. Among older children measles was more common in HIV positive children (8/42 (19%) v 2/48 (4%); P < 0.06). Pyogenic meningitis was present in similar proportions of HIV positive and HIV negative children aged < 15 months (7/36 (19%) and 7/29 (24%)). In HIV positive children tuberculosis (1/78), lymphocytic interstitial pneumonitis (1/78), and HIV encephalitis (2/78) were rare.
Conclusions:
There is greater overlap between diseases associated with HIV infection and other common health problems in African children than there is in adults. Compared with adults, HIV positive children had a high prevalence of P carinii pneumonia and a low prevalence of tuberculosis. Measles, but not malaria, was associated with HIV infection.