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Objective@#Pediatric HIV is a national health concern that has grown exponentially in the past 5 years. This study aimed to determine the clinico-demographic profile and outcome of pediatric HIV/AIDS patients 0-18 years old seen at the Western Visayas Medical Center (WVMC) HIV/AIDS Treatment Hub from March 2006 to September 2018. @*Methods@#Medical chart records of all pediatric HIV/AIDS patients seen at the treatment hub during the study period were reviewed. Data on clinical and demographic profile and outcomes were gathered and descriptive statistics was used to analyze data. @*Results@#A total of 30 children 0-18 years old were registered consisting of 29 (97%) males and 1 (3%) female. A sudden increase in pediatric HIV patients was noted in the past 3 years, mostly among male adolescents engaged in male-to-male sexual contact (MSM). Majority (73%) were symptomatic at diagnosis with flu-like symptoms, fever and vomiting. Common physical exam findings were lymphadenopathy and rashes. HIV-related infections were tuberculosis and pneumonia. About 60% of study participants had severe immunodeficiency. Two-year mortality rate was 38%. Correlation of age and baseline CD4 count with outcome did not show any significant results. @*Conclusion@#Pediatric HIV/AIDS patients were symptomatic, male adolescents who engaged in male to male sexual contact. Co-infections with pneumonia and tuberculosis were common and severe immunodeficiency was present at diagnosis. Thirty-eight percent of patients had poor outcomes 2 years after diagnosis
Subject(s)
HIV , Acquired Immunodeficiency SyndromeABSTRACT
Background: The pattern and rates of disclosure of HIV status to infected children may differ within a country, and among the states, based on the socioeconomic, cultural, and even health status. Understanding this pattern is important in the formulating guidelines of disclosure on their HIV diagnosis to children infected by HIV, and to design strategies for improvement of adherence. This study was proposed to study the pattern of disclosure of HIV status in children aged 6 to 17 years.Methods: This cross sectional study was conducted for a year (2016-2017) at a Pediatric HIV clinic in Thrissur, Kerala. Participants for this study were 58 HIV-infected children in the age group of 6-17 years who were on ART, and their parents/caregivers.Results: Among the 58 participants, only 25 (43.1%) were aware of their HIV status, either fully (17; 68%) or partially (8; 32%). Healthcare providers were more likely to disclose the status to the affected child. Majority of the participants (84%) had better compliance to therapy after disclosure and most of the children in the non-institutional group were more supportive towards their parents (50%) after disclosure. The factors that were associated with disclosure in the non-institutional group were age of the child and duration of therapy.Conclusions: Children infected with HIV showed better adherence after complete disclosure. Rate of disclosure can be improved by reviewing the disclosure hurdles in our state so that intervention programs can be planned for improving the rate of disclosure.
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Introduction@#Infection with HIV is multi-faceted and involves the interplay of medical, social, and economic factors thus, management of the disease continues to be a challenge to most physicians. The Philippines is experiencing a surge in cases since 2013. Understanding the local epidemiology of pediatric HIV may reveal opportunities to reduce or eliminate transmission through timely diagnosis. @*Objective@#This study was conducted to identify the features and outcome of children living with HIV in a hospital where a program for HIV treatment and monitoring was implemented. @*Methodology@#Medical records of all children Guidance Intervention Prevention (SAGIP) Unit were reviewed. Data was analysed using descriptive statistics. @*Results@#Thirty pediatric HIV patients were included in the study. The most common mode of acquisition is by sexual transmission (57%) and most patients were male (76%),bisexual (47%), and heterosexual (47%). Weight loss (50%),rash (50%), fever (37%) and cough (37%) were the most common clinical findings. The most common opportunistic infections were tuberculosis (47%) and oral candidiasis (34%). Only 27 of 30 patients were started on antiretroviral therapy within 6 months from diagnosis. One patient showed resistance to a non-nucleoside reverse transcriptase inhibitor (NNRTI). There were 11 children who died of various opportunistic infections and its complications, while 2 were transferred to a different treatment hub after 6 months, and 1 lost to follow-up. @*Conclusion@#Sexual means of HIV transmission among adolescents is evident in this study. Weight loss, cough, rash, fever, and lymphadenopathy are common presenting features. Tuberculosis and oral candidiasis are the most common opportunistic infections and should alert physicians on possible HIV infection. A mortality rate of 37% was noted mostly in the first 6 months of initiating ART treatment.
Subject(s)
HIVABSTRACT
Introduction: Pediatric antiretroviral therapy (ART), changed the prognosis of the disease, allowing young women infected by vertical transmission (TV) to be pregnant without risk for their fetus of acquiring this infection. Aim: To describe the clinical-immune status in pregnant women that acquired HV by vertical transmission, treatments received, monitoring of pregnancy and newborn characteristics. Material and Methods: A protocol was performed, evaluating clinical and immunological parameters during pregnancy, ART used, protocol preventing vertical transmission (PPTV), and follow up of children to 18 months of age. Results: Of 358 HIV-positive patients vertically infected, five women became pregnant, between 14 and 24 years old. Pregnancies were controlled in clinical/immune-stage N2 C3. They had received two to five therapies. Full PPTV was performed in all binomials. Pre-natal undetectable viral loads ranged from 4,700 ARN copies/mL. Five living children were born by Caesarean section, four of them with 37 weeks of completed gestation and one of them with 34 weeks of gestation. All received zidovudine (AZT) for 6 weeks. CD4 at 72 hours of life ranged from 48% to 74.6%. All children were born uninfected with HIV. Only two had mild anemia. Conclusions: Expectations of HIV mothers vertically infected to have healthy children are similar to those infected by horizontal transmission, using PPTV
Introducción: La terapia anti-retroviral en pediatría (TARV), cambió el pronóstico de la enfermedad, permitiendo embarazarse a mujeres jóvenes infectadas por transmisión vertical (TV). Objetivos: Conocer las características clínico-inmunológicas de las mujeres embarazadas, tratamientos recibidos, condición al embarazo y seguimiento de sus recién nacidos. Material y Método: Se efectuó un protocolo, evaluando etapas clínico-inmunológicas en el embarazo, TARV usadas, protocolo de prevención de transmisión vertical (PPTV) y seguimiento de los niños hasta 18 meses. Resultados: De 358 pacientes con infección por VIH adquirida por TV, cinco mujeres se embarazaron, con edades entre 14 a 24 años, embarazos que fueron controlados por el equipo de salud, encontrándose en etapa clínico-inmunológica N2 a C3. Habían recibido dos a cinco esquemas de TARV. Se efectuó PPTV completo en todos los binomios. Las cargas virales previas al parto fluctuaron entre indetectable y 4.700 copias ARN/ml. Nacieron por cesárea cinco niños vivos, cuatro de término y uno con 34 semanas de gestación. Todos recibieron zidovudina (AZT) durante seis semanas. Los CD4 a las 72 h de vida fluctuaron entre 48 y 74,6%. Ninguno de los niños adquirió la infección por VIH en forma vertical. Sólo dos presentaron anemia leve. Conclusiones: Las expectativas de madres con infección por VIH de adquisición vertical de tener hijos sanos son semejantes a las infectadas por transmisión horizontal, al usar PPTV.
Subject(s)
Humans , Male , Pregnancy , Infant, Newborn , Adolescent , Young Adult , Pregnancy Complications, Infectious/virology , HIV Infections/transmission , Infectious Disease Transmission, Vertical/prevention & control , Anti-HIV Agents/therapeutic use , Pregnancy Complications, Infectious/drug therapy , Pregnancy Outcome , HIV Infections/immunology , HIV Infections/prevention & control , Follow-Up Studies , CD4 Lymphocyte Count , Viral Load , Drug Therapy, Combination , GenotypeABSTRACT
Background: An increasing number of HIV infected children have been reported as spread of HIV in adults are showing increasing trend in India. We reported the clinical manifestation, laboratory parameters and follow up of these children. Aim: To study the clinical profile follow up of paediatric patients admitted with HIV in the age gruop18 months to 13 years for a period of 1 year. Materials and methods: This Prospective study was conducted at tertiary care centre at Gandhi Hospital in association with ART centre, Ganhi Hospital, Secunderabad over a period of one year (January 2013 - December 2013). Over 100 consecutive patients suspected and later confirmed by TRIDOT & HIV EIA COOMB were included in the study after obtaining written consent from guardian of the patients. A detailed history, thorough clinical examination and laboratory investigations were carried out. ART & ATT therapy were given according to guidelines and followed up. Results: Of the 100 cases, 55 were males and 45 were females. Immunization status of these children included 20%completely immunised, 52% partially immunized and unknown in 28. Clinical manifestation like, anemia was seen in 95 cases, 91 cases had PEM with 47.25% were in gr 4, PGL (38), fever (36), respiratory (28), diarrhoea (15). Less commonly seen were CNS and chronic Gummadivandanaushasree, Sreenivasaiah Bharathi, Jampalavenkateshwar Rao. Clinical profile and follow-up of HIV infection in pediatric age group beyond 18 months up to 13 years at tertiary level hospital. IAIM, 2016; 3(10): 125-138. Page 126 ottorhea. Most common opportunistic infections were tuberculosis (16) and candidiasis (16) with giardiasis (3) and herpes zoster (2). Of the 100 cases enrolled, 11 were lost to follow up and 3cases died. Mean weight gain after 6 months 1.6 SD and 2.8 SD at 12 months. On laboratory investigations 95 cases had Hb <2SD, 21 had mantoux positive (>5 mm), abnormal chest X-ray in 23 cases. Conclusion: Most children were in the age group of 1-5 years with mean age of presentation of 5.5 years. Mild bias towards male patients is noted. Perinatal mode is the only mode of transmission, no other modes noted. Most of the children presented to us in a partially immunized status and others’ status was not known. Common presentations - PEM, anemia, skin manifestations, nutritional deficiencies, prolonged fever, systemic manifestations – PGL; respiratory infections like pneumonia, TB; chronic diarrhoea. CNS manifestations were uncommon and renal problems, malignancies were not noted in our study. Amongst opportunistic infections, TB involving various organs and candidiasis were seen in maximum number of patients. Our study concluded that administration of nevirapine based ART regimes for HIV-1 infected children is feasible in resource limited settings. There was improvement in growth parameters with the use of this therapy and prevention of deterioration in immune status.
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We report a 2 year 6 months old girl suffering from HIV infection and presenting with two giant condyloma acuminata of perianal and perivulvar region along with oral candidiasis.
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This pilot study was aimed at testing the feasibility of using a standardized questionnaire as a screening tool for detection of pediatric HIV at first contact. A prospective study was carried out on a cohort of 400 new patients attending the pediatric outdoor patient department in Medical College, Kolkata. After examining, the attending physician noted his clinical impression, filled the standardized questionnaire and scored each patient. ELISA test was performed. The results of the diagnostic tests were correlated with the clinical impression and the score. Taking a score of 9 as the cut-off, the sensitivity and specificity of the scoring system was 95.7% and 98.6%, respectively. We conclude that this clinicoepidemiological scoring system may be used to screen children for HIV in resource-limited settings.
Subject(s)
Ambulatory Care/methods , Child , Child, Preschool , Early Diagnosis , Feasibility Studies , Female , HIV Infections/diagnosis , Humans , Infant , Male , Mass Screening/methods , Pilot Projects , Prospective Studies , Surveys and Questionnaires , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
La infección VIH en pediatría, muestra diversidad de manifestaciones cuyo reconocimiento permite una precoz aproximación diagnóstica. Determinar las manifestaciones inicieales en pacientes pediátricos con infección VIH. Estudio comparativo y retrospectivo, incluyendo pacientes con infección VIH del Hospital de Niños "J.M de Los Ríos" (Caracas, Venezuela) entre 1987-2006. Los datos fueron obtenidos de la base de datos de la consulta. Según la forma de transmisión del VIH se establecieron dos grupos: vertical y horizontal. Se registró la manifestación inicial y la edad de presentación, así como la edad del diagnóstico VIH. Las frecuencias fueron comparadas por el método chi cuadrado. Se incluyeron 191 pacientes: grupo vertical 80,1 por ciento y grupo horizontal 19,9 por ciento. Del total 5,2 por ciento estaban asintomáticos, 33,5 por ciento tenían manifestaciones inespecíficos, 41,9 por ciento tenían síntomas VIH/no SIDA y 19,4 por ciento tenían síntomas VIH/SIDA. Las manifestaciones más frecuentes fueron: linfadenopatías generalizadas (25 por ciento), hepatomegalia (16,1 por ciento), infecciones respiratorias altas recurrentes y persistentes (15,1 por ciento), infecciones bacterianas severas (18,2 por ciento), diarrea crónica (11,4 por ciento) y esplenomegalia (10,9 por ciento). La edad de la primera manifestación fue de 0,9 ± 0,7 años en el grupo vertical y 5,5 ± 3,9 años en el grupo horizontal. La edad del diagnóstico VIH fue 2,8 ± 2,7 años en el grupo vertical y 7,6 ± 4,9 años en el grupo horizontal. Las manifestaciones inespecíficas fueron las más frecuentes: linfoadenopatías generalizadas, hepatomegalia e infecciones respiratorias altas. Sin embargo, las infecciones bacterianas severas y la diarrea crónica, constituyen manifestaciones relevantes para la sospecha de infección VIH. El diagnóstico se realizó como mínimo 2 años después de la primera manifestación en ambos grupos.
Pediatric HIV infection shows different manifestations whose recognition allows an early diagnostic approach. To determine the initial manifestations in HIV pediatric patients. It was a comparative and retrospective study that included HIV patients who attended to Hospital de Niños J.M de Los Ríos (Caracas, Venezuela), between 1987-2006. Data were obtained from HIV consultation Data Base. According to HIV transmission, we established two groups: vertical and horizontal. The initial manifestation and the patient age at that moment were recorded, so was the HIV diagnosis age. The frequencies were compared by square chi method. There were 191 patients: 80,1% in the vertical group and 19,9% in the horizontal one. There were 5,2% of asymptomatic patients, 33,5% had inespecific manifestations, 41,9% had HIV/no AIDS symptoms and 19,4% had HIV/AIDS symptoms. The most frequently seen manifestations were: generalized lymphadenopathy (25%), hepatomegaly (16%), recurrent and persistent upper respiratory tract infection (15,1%), severe bacterial infection (18,2%), chronic diarrhea (11,4%) and splenomegaly (10,9%). The age at the first manifestation was 0,9 ± 0,7 years in the vertical group and 5,5 ± 3,9 years in the horizontal one. The HIV diagnosis age was 2,8 ± 2,7 years in the vertical group and 7,6 ± 4,9 years in the horizontal one. The most frequent manifestations were inespecific: generalized lymphadenopathy, hepatomegaly and upper respiratory tract infection. However, severe bacterial infections and chronic diarrhea are relevant manifestations to suspect HIV infection. HIV diagnosis was done at least two years after the first manifestation in both groups.