Human immunodeficiency virus seropositivity in children aged six to eighty-four months at Kenyatta National Hospital

To determine the prevalence of the HIV seropositivity in general paediatric emergency admissions at Kenyatta National Hospital; 552 children were studied systematically for four months in 1991.A clinical history was taken and physical examination conducted. The HIV status was determined by use of organ Teknika's Vironostika viral lysate assay for initial two screenings and then a Behring enzygnost anti-HIV-1 synthetic peptide assays a confirmatory assay.Seventy (12.7) of all the children studied were HIV positive; the mean age of the HIV-positive children was 17.5 months while that of the total study population was 23.5 months. HIV seropositivity was not associated with history or parenteral injections. No haemophilia patient was recruited during the study period; and of all the 18 sicklers recruited; none was HIV positive despite multiple blood transfusions. The WHO paediatric Aids Case definition criteria had moderately low sensitivity (55.7); high specificity (85.9) and low positive predictive value (36.4). This was in agreement with observations noted in other studies in East and Central Africa

Long term follow-up of HIV-1 exposed children in Nairobi

Transmission of HIV-1 from an infected mother to her infant is the major route of transmission of this infection for children. In sub-saharan Africa where heterosexual transmission of HIV is the commonest mode of spread; high prevalence of HIV infection in women of child bearing age is bound to lead to increased paediatric AIDS as a result of vertical transmission. In recognising these epidemiological factors; the University of Nairobi HIV-1 Perinatal Transmission and Paediatric AIDS Project was initiated in 1986. Antenatal mothers attending Pumwani Maternity Hospital were enrolled during labour and screened for HIV-1 infection by ELISA. Those reacting positive were recruited to participate in the study. An equal number of negative controls were also recruited. The mothers and babies of both groups were followed for varying periods over the next five years. A total of 360 babies born to HIV infected mothers and 360 babies born to HIV negative mothers were examined. The mortality rate observed in the HIV-1 exposed was substantially higher than that observed in controls (RR2.8; 95CI1.3-6.1). Common causes of death among infected infants were pneumonia; measles; malaria; gastroenteritis; tuberculosis and spticaemia. The five year survival was 85 among HIV infected children. Maternal risk factors associated with transmission were marital status; duration of sexual activity and age at first intercourse

Invasive pneumococcal disease in a cohort of HIV-1 infected female prostitutes living in Nairobi

A cohort of predominantly HIV seropositive female prostitutes has been followed for a two year period. 54 episodes of invasive pneumococcal disease (ISpD) have been diagnosed in 41 patients; of which 28 were bacteraemic. All patients were seropositive for HIV. Pneumonia was the most common presentation in 34(64); then maxillary sinusitis in 11 (21) and occult bacteraemia in 8 (15). Nine of the patients (22) had proven recurrent disease despite appropriate therapy; most of these episodes were with different serotypes suggesting that this is reinfection rather than relapse. The mean CD4 count of first episode ISpD was 325 showing that that this is an early HIV-related problem. The estimated inicdence rate was 30/1000 person years of observation and it was the most common life-threatening problem seen in the cohort in the study period. All patients survived with standard penicillin or ampicillin treatment. The pneumococcus is an important but under-recognised cause of HIV-related disease in Africa. Presentation can be atypical but the response to appropriate therapy good