Paediatrics HIV/AIDS: Clinical Presentation and Practical Management Challenges in Sokoto; Nigeria

ABSTRACT

Background: Implications of continuing HIV/AIDS pandemic in Nigeria is very grave for children. Lack of financial resources means care of children with HIV/AIDS is exceedingly difficult to provide. We described the clinical pattern and highlight the problems in the management of HIV/AIDS in children seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH); Sokoto; Nigeria over a two-year period. Methods: This prospective study was carried out between 1st January 2001 and 31st December 2002. The clinical presentation of each patient satisfying the WHO diagnostic criteria for paediatrics HIV/AIDS; admitted consecutively into our Emergency Paediatrics Unit (EPU) was documented. Laboratory diagnosis was by Enzyme linked immunosorbent assay (ELISA) for HIV- I and HIV- II in affected children and their mothers while confirmatory test was by Western blot. Treatment of each patient was individualised. Results: A total of 41 children with HIV/AIDS were admitted into EPU over the study period. There were 22 males and 19 females with ratio of 1.21. Age ranged from 0.25 years to 14 years with mean (SD) of 1.5 (2.2) years. Forty - one (97.6) patients were aged 5 years and below. Modes of transmission were vertical in 40 (97.6); while 1 (2.4) was by homosexual abuse. The commonest clinical feature was weight loss in 41 (100); followed by fever (one month) 39 (95); chronic diarrhoea 39 (95); recurrent cough 37 (90) and oro-pharyngeal candidiasis 35 (85) in that order. Thirty- six (87.8) patients had protein - energy malnutrition (PEM); marasmus constituting 58. Thirtytwo (78) patients were in WHO clinical stage 3 while the remaining 9 (22) patients were in stage 4. The main types of infections were oral candidiasis; pneumonia; malaria; septicaemia; urinary tract infections; and tuberculosis. Case fatality rate was 91. Highly active antiretroviral therapy (HAART) was not freely available to children during the period of our study. Conclusion: The mortality of these antiretroviral naive HIV/AIDS children was very high. It is anticipated that current availability of HAART to children free of charge would improve the outcome of HIV/AIDS in this group