Prevalence of HIV Type 1 Infection, Associated Clinical Features and Mortality among Hospitalized Children in Dar es Salaam, Tanzania

Abstract

The aim of this study was to determine the prevalence of HIV-1 infection, the clinical spectrum of HIV-1-associated conditions and HIV-1-associated mortality among children hospitalized in the medical paediatric wards at Muhimbili Medical Centre (MMC), Dar es Salaam, Tanzania. All children admitted to the medical paediatric wards of MMC between August 1995 and January 1996 were eligible for the study. Testing for HIV antibodies was done using 2 consecutive enzyme linked immunosorbent assays (ELISAs). ELISA-reactive samples from children aged 18 months and below were further tested by a recently developed heat-denatured p24 antigen assay. The prevalence of HIV-1 infection among the 2015 children studied was 19.2%. When present for 14 days or more, fever, cough, diarrhoea, ear discharge, oral ulcers and skin rash were all significantly more common in HIV-1-infected than in HIV-uninfected children (p < 0.001). In the multivariate analysis cough, ear discharge, oropharyngeal ulcers and skin rash were found to be the most important symptoms. Clinical signs found to be significantly associated with HIV-1 infection in the univariate analysis were wasting, stunting, hair changes, oral thrush, oropharyngeal ulcers, lymphadenopathy, lung consolidation and lung crepitations (p < 0.001). In the multivariate analysis, oral thrush, lung crepitations, cervical lymphadenopathy, wasting and inguinal lymphadenopathy were found to be the most important signs. The 3 most common diagnoses in HIV-1-infected children were acute respiratory infection (ARI) (39.4%), malnutrition (38.1%) and tuberculosis (19.3%), while in HIV-uninfected children they were malaria (47.0%), ARI (25.0%) and malnutrition (16.1%). The mortality rate was 21.4% in HIV-1-infected children and 8.4% in HIV-uninfected children (p < 0.001). In conclusion, the prevalence of HIV-1 infection among hospitalized children at the main hospital in Dar es Salaam was high and associated with high mortality. Many symptoms and signs are indicative of HIV-1 infection, but appropriate laboratory testing is required for diagnosis.

Prevalence of Underweight, Stunting, and Wasting among Children Infected with Human Immunodeficiency Virus in South India

“…This is important as malnutrition has a major impact on the outcome of HIV disease as it not only increases mortality [12, 13] but also results in an impaired response to antiretroviral therapy [14]. Rajasekaran et al showed that children who were severely malnourished at baseline, had a hazard ratio of 6.7 (0.9–49.4) for mortality after initiation of ART, compared to children who were normally nourished [14].…”

Detecting virological failure in HIV-infected Tanzanian children

“…[3] The World Health Organization (WHO) advocates a public health approach to ART, recognising the potential role of plasma HIV-1 RNA testing but recommending clinical and immuno logical monitoring in resource-constrained countries such as Tanzania. [4,5] It has been shown that there are challenges related to the use of clinical and immunological parameters to detect virological failure in adults receiving ART. The delay in recognition may result in increased acquisition of HIV drug-resistant mutations as well as increased morbidity and mortality.…”

Impact of multivitamin and mineral supplements on mortality and nutritional status of hospitalized severely malnourished HIV/AIDS infected children

“…Despite the efforts made, in low-income countries, many infants continue to be infected each year and often die prematurely. Infant HIV mortality rate, in the absence of treatment, is the greatest during the early years of life [1,2]. In low-income countries, HIV/AIDS infected children care interventions coverage remains very low, specifically in rural areas.…”