Growth, developmental, and behavioral outcomes of HIV-affected preschool children in Thailand.

In order to determine growth, developmental, and behavioral outcomes of Thai HIV-affected preschool children, a cross-sectional study was performed at Chiang Mai University Hospital. Thirty HIV-affected children aged 3 to 5 years and 35 of age-matched control with their respective caregivers participated. There was no difference in growth and behavioral outcome, as measured by a standardized Child Behavioral Checklist, between the two groups. Cognitive functioning, as measured by a Thai intellectual assessment score, was significantly lower in the HIV-affected group (p = 0.03). Twenty percent of the HIV-affected group had below average level IQ (< or = 89) compared to 11% in the control. The risk factors were low caregivers' family income and being brought up by relatives as opposed to biological parents. An early intervention program for these children should be promoted as a result.

Cryptococcosis in HIV-infected children.

Between January 1994 and December 2001, 21 HIV-infected children were diagnosed as having cryptococcosis. The 8-year point prevalence of cryptococcosis among hospitalized HIV-infected patients was 2.97%. Medical records of 19 patients were available for review. Sixteen patients had cryptococcal meningitis. Of these patients, cryptococcal antigen in the cerebrospinal fluid and sera were positive in all tested samples. India ink preparations were positive in 94% of cases. However, the routine CSF examination was normal in 50% of cases. All patients but one received antifungal treatment. Six patients died during treatment, the others (13 patients) were successfully treated. Relapse occurred in 2 patients despite secondary prophylaxis. Two patients died later from other causes and nine were lost to follow-up. We conclude that cryptococcal meningitis was the most common clinical presentation of cryptococcosis among HIV-infected children. HIV-infected children who present with fever, with or without central nervous system signs, should have a lumbar puncture and CSF sent for cryptococcal antigen and culture.

An in-house HIV DNA PCR assay for early diagnosis of HIV infection in children in Thailand.

Eighty-five venous blood specimens were collected at 4, 6 or 9 months of age from asymptomatic human immunodeficiency virus (HIV)-exposed infants and from symptomatic HIV-infected infants on admission to the hospital. The specimens were tested by in-house HIV deoxyribonucleic acid (DNA) nested polymerase chain reaction (PCR) and the commercial Amplicor HIV-1 DNA test. In order to determine the accuracy of the tests, the results were compared with the HIV infection status of the children. In-house HIV DNA PCR and the commercial Amplicor HIV-1 DNA test had overall sensitivity of 95.2 per cent and 100 per cent and an overall specificity of 100 per cent and 98.4 per cent, respectively. In the analysis of 62 HIV-exposed infants who received perinatal HIV prevention intervention, in-house HIV DNA PCR yielded 100 per cent sensitivity, specificity, positive predictive value and negative predictive value. The authors concluded that in-house HIV DNA PCR has comparable sensitivity and specificity to the Amplicor HIV-1 DNA test in detecting the HIV infection status of children born to HIV-infected mothers. The in-house HIV DNA PCR, which costs US $10 per test, should be considered in developing countries for the early diagnosis of HIV-1 infection in children.