Predictors of HIV testing and serostatus amongst children admitted to Port Moresby General Hospital.

The aim of this study was to identify factors associated with current HIV (human immunodeficiency virus) testing practice at Port Moresby General Hospital and positive serostatus among children tested, as a basis for contributing to guidelines on HIV testing for children in Papua New Guinea. Data were extracted from hospital records to determine the demographic and presenting clinical characteristics of admitted children tested for HIV serostatus between 1 December 2005 and 30 November 2006. These data were compared with corresponding data from untested control children from the same wards. The same characteristics were compared between seropositive and seronegative cases. Odds ratios were derived for potential predictors of testing and its outcome. During the study period, HIV tests were reported on 215 children, of whom 57 were seropositive. Controls were 264 untested children. Tested children were more likely to be aged 18 months or less, to have been admitted for more than 7 days, and to have diarrhoea, be malnourished or have oral candidiasis. Among children tested, suspected tuberculosis as a presenting illness was significantly predictive of HIV-positive serostatus. This study indicates that certain clinical factors associated with HIV-positive status in children may not yet have been incorporated into testing practice, and underlines the importance of developing a systematic approach to testing children for HIV in Papua New Guinea.

A mutation in the mucosal keratin K4 is associated with oral white sponge nevus.

White sponge nevus (WSN) is a benign autosomal dominant disorder which affects non-cornifying stratified squamous epithelia (MIM 193900) (ref. 1). Phenotypically it presents as white 'spongy' plaques (oral leukokeratoses), most commonly in the mouth but also reported in the esophagus and anogenital mucosa. Histologically, the plaques show evidence of hyperproliferation, acanthosis and tonofilament aggregation. These types of pathogenic changes are characteristic of many of the epidermal keratin disorders. Keratins are expressed in pairs by epithelial cells in a tissue and cell specific manner. The major differentiation specific keratins of the buccal mucosa, nasal, esophageal and anogenital epithelia are K4 and K13 (ref. 7). The tissue distribution and nature of the lesions in patients affected by WSN suggested that mutations in K4 and/or K13 might be responsible for this disorder. We have now confirmed this hypothesis and report here a three base-pair (bp) deletion in the helix initiation peptide of K4 in affected members from two families with this condition.