A study on clinical profile of paediatric HIV infection in the age group of 18 months to 12 years and its correlation with CD4 count

INTRODUCTION: World over 38.6 million people are living with HIV, follow of which 2.3 million i.e. 5.9% are children <15 years of age. • In 2007 – 4,20,000 children were newly infected. • Estimated children living with HIV / AIDS in India is 0.17 – 0.24 million (3.5-5% of people with HIV). • Prevalence of HIV in pregnant mother is 0.6% - 0.7% (National). • Adult prevalence is 0.36% (0.43% males and 0.29% females). • Children account for 18% of total deaths due in AIDS i.e. 1 in every six AIDS death every year is a child, but they are < 1 in every twenty five persons getting treatment. AIM OF THE STUDY: 1. To study the clinical profile of pediatric HIV infection in the age group of 18 month to 12 years. 2. To correlate the clinical features with the CD4 count. MATERIALS AND METHODS: Nature of Study: Descriptive study. Study population: 100 children who were registered in ART centre over a period of 1 year were taken. Period and Place of study: This study was conducted over a period of 1 year from Oct 2007-Oct 2008 at Govt. Mohan Kumaramangalam Medical College Hospital, Salem. Inclusion Criteria: Children who got registered in ART centre in the age group of 18 months to 12 years, whose diagnosis in confirmed by Rapid antigen tests or ELISA were included. Exclusion Criteria: Children <18 months were not taken as the facility for making diagnosis by PCR was not available in our centre. SUMMARY: 100 children who were infected with HIV were taken as study group. Among them, Asymptomatic were 22%, Symptomatic were 78%, PEM observed in 76% cases and severe PEM was noticed (Grade III and IV and) in 22%. Among the symptomatic HIV infected children the clinical feature that were observed, Generalised lymphadenopathy – 46%. Lymphadenopathy alone observed in 10% with average CD4 count being 25%. Lymphadenopathy associated with other features of stage II to IV HIV infection like pneumonia, skin lesions, oral lesions, severe PEM constitute about 26% and the average CD4 count in this group being 12-18%. Generalised lymphadenopathy was the most common clinical manifestation in this study. • Skin lesions were observed in 29% of children. Pruritic papular eruption being the common finding observed in 14 children with average CD4 % is bet (24 – 35%). Other lesions like scabies (CD4 11%), Herpes (CD4 7 – 31%) molluscum (CD4 11%). Extensive impetigo (CD4 11%) were also observed. These lesions were associates with low CD4 count. • Among oral lesion that were observed oral candidiasis was found in 3% and associated with low CD4 count (8-10%). • Among opportunistic infections, tuberculosis was found to be the commonest infection which was 30% (This include all forms of TB). • Severe anemia (<8g%) was found in 16% which were predominantly in the children belong to stage III a stage IV illness, who were also associated with low CD4 count. • As for as Nutritional status in concerned, children in stage IV disease belong to Grade III & IV PEM and height being <85% of the expected, where us, majority of stage I disease children have Grade IPEM. • MTC transmission accounts for 97% and being the majority one. • Only one was delivered by emergency LSCS and the rest were delivered by normal vaginal delivery. For one child mode of delivery not known. • Only one child was replaced with milk substitute and given neviripine? perinatally. Rest of the children were given either Breast milk or mixed (both BF & Cow’s milk) not received Neviripine. • Since children infected with HIV having, Asymptomatic generalised lympadenopathy, skin lesions like eczema, pruritic papular eruptions, oral lesions like glossitis and gingivostomatitis were associated with the high CD4 count, intensifying the screening for HIV infection by high suspicion will help in diagnosing HIV infected children at the earliest, and thus they can be subjected to early management and follow up periodically. Early management include – chemoprophylaxis, immunization, management of opportunistic infection, nutritional support and ARV Therapy. • Proper ART to AN mother who were identified as HIV infected, ART to mother and baby during peripartum period, Elective LSCS, proper milk substitution will definitely found to be effective in reducing MTC transmission.