Bacteria urinary tract infection in HIV-infected children and adolescents in Abuja, Nigeria: a cross-sectional study

Background: Urinary tract infection (UTI) remains the second commonest opportunistic infections among HIV infected children. This study was conducted to determine the prevalence and causative bacteria of UTI in HIV infected children and adolescents on antiretroviral medications in our health institution. Method: The study was a cross sectional design conducted between October 2017 and March 2018 among HIV infected children and adolescents aged 2 months to 18 years on follow up attendance at the Paediatric Outpatient Special Treatment Clinic (POSTC) of University of Abuja Teaching Hospital (UATH). Early morning midstream urine was collected from each participant for urinalysis, microscopy and aerobic bacterial culture. Bacteria were identified from culture by standard microbiological methods and antibiogram of the isolates was determined by the disk diffusion method. Result: Of 166 HIV infected children and adolescents studied, 106 (63.9%) were males, 82 (49.4%) were in age group 5-10 years, and 110 (66.3%) were from lower socio-economic class. Significant bacteria (UTI) were isolated in 54 (32.5%) subjects, with 38 (70.4%) from females, and 51 (94.4%) from those on first line antiretroviral therapy. Isolates recovered were Escherichia coli 20 (37.0%), Klebsiella pneumoniae 16 (29.6%), Staphylococcus aureus 8 (14.8%), Pseudomonas aeruginosa 6 (11.1%), and Proteus mirabilis 4 (7.4%). Leucocyturia in 19 (35.2%), nitrituria in 10 (18.5%), and haematuria in 15 (27.8%) subjects with significant bacteriuria were also recorded. Isolates were sensitive to ofloxacin (81.5%), nalidixic acid (74.1%) and cefuroxime (61.1%), while they were resistant to cotrimoxazole (100%), ampicillin (98.1%) and piperacillin (94.4%). Significant difference was observed in the mean CD4 cell count and viral load of subjects with significant bacteriuria compared to those without; 838.6 ± 177.8 versus 1009.9 ± 234.7 cells/µL (p=0.02), and 10, 360.5 ± 471.0 versus 5, 840.8 ± 563.8 copies/ml (p=0.003) for CD4 cell count and viral load respectively. Conclusion: This study reported a high prevalence of UTI among HIV infected children and adolescents, especially in those with high viral load. Routine screening for UTI should be offered to HIV infected children and adolescents with high viral load

The impact of prevention of mother to child transmission of HIV programme in the Federal Capital Territory, Abuja

BACKGROUND:Human Immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS) is spreading rapidly among the world's children especially in Sub-Saharan Africa. Mother-to-child transmission (MTCT) is the major route of acquired this disease in children. Prevention of mother-to-child transmission (PMTCT) of HIV programme is aimed at reducing HIV/AIDS in children to its barest minimum. The aim of the present study is to determine the impact of PMTCT programme on HIV exposed infants in the Federal Capital Territory (FCT), Abuja. METHOD:A six month prospective study of 160 HIV exposed infants attending Paediatric Outpatient Special Treatment Clinic (POSTC) of the University of Abuja Teaching Hospital (UATH) was carried out. Exposed infants were categorized based on their participation in the PMTCT programme. Deoxyribonucleic acid (DNA) Polymerase Chain Reaction (PCR) test was used for early diagnosis of HIV infection in the study infants.RESULTS: Overall transmission rate of HIV infection among the study subjects was 33.7%. Transmission was found to occur in 6.7% of infants who participated in PMTCT programme and in 68.6% of those not involved in the programme, P < 0.001. For infants in the full programme, transmission occurred in 2.7% of cases and in 25.0% among those involved partially, P < 0.05. CONCLUSION: The study shows that transmission of HIV infection to exposed infants is high in FCT, Abuja. Transmission was however found to be significantly lower in infants who participated in PMTCT programme and even much lower in those involved in the full programme. It is therefore recommended that there is an urgent need to establish full PMTCT programme in many health care facilities across the nation as a major way of reducing paediatric HIV/AIDS in the country

The Clinical Features of Paediatric HIV/AIDS at Presentation at the University of Abuja Teaching Hospital; Gwagwalada

Background: The reported geographical differences in the HIV-1 sub-type across the continent and the entire world makes it necessary to investigate whether the clinical presentation and outcome of such presentation can demonstrate differences in the multiple sub- type of HIV-1 infection. To determine whether the clinical presentations and outcome of HIV/AIDS in children in Abuja; Nigeria conforms with reports from elsewhere both within and outside the country. Method: A one- year prospective study of HIV infected children attending the University of Abuja Teaching Hospital (UATH); Gwagwalada; from November 2006 to October 2007;was carried out to determine the clinical presentation and outcome of such presentation in the area. Results: A total of 173 patients were diagnosed with signs and symptoms of HIV/AIDS and on antiretroviral therapy (ARVT). There were 90 (52.0) males and 83 (48.0) females giving a male to female ratio of 1.1:1. Less than 5 years constituted 81.5of paediatric patients seen; with less than 2 years responsible for 52.0of cases; and 11.8being those between the ages of 10-15 years. The commonest presenting complains were that of recurrent fever (80.3); progressive weight loss (77.5); and persistent diarrhoea (69.1). Chronic cough (62.2) and skin rashes (52.7) were equally common. While persistent diarrhoea; oral thrush; discharging ear; and failure to thrive were commoner in children less than two years; generalised lymphadenopathy; skin rashes and parotid swelling were commoner in older children. Mortality rate was found to be 3.5; while WHO case definition for paediatric HIV/AIDS in African setting was found to be sensitive with low specificity and positive predictive value (PPV). Conclusion: Clinical presentation of paediatric HIV/AIDS appears similar with reports from other centers in spite of the wide variation in HIV-1 sub-types. Mortality was also found to be low. This was attributed largely to the availability of free antiretroviral drugs (ARVD); potent antibiotics and anti-fungal agents which were made freely available to HIV infected patients. The findings underscore the need for government to extend such services to HIV/AIDS patients across the country as a major way of reducing the sufferings of this scourge in children