Clinically directed selective screening of HIV in Indian children: Which criteria to choose?

Abstract

Pediatric human immunodeficiency virus (HIV) infection can have varied presentations but these manifestations usually are non-specific. Probability of HIV infection in a given clinical manifestation has been examined in a very few studies including a study conducted at Bloemfontein, South Africa. This study evaluated the usefulness of world health organization (WHO) case definition to screen HIV positive children and proposed a new case definition, which was said to be more sensitive than WHO case definition (63.2 vs 14.5%). This study aims to assess the usefulness of South African (SA) Criteria for screening of HIV in hospitalized children in Indian setup and to compare its sensitivity with that of the WHO case definition. Design: Prospective investigational study. Setting: A tertiary care teaching institution of central India. Total 110 hospitalized patients aged 18 months to 14 years were included who fulfilled either SA or WHO criteria. HIV Enzyme-Linked ImmunoSorbent Assay (ELISA) test was performed on recruited patients. Intervention: None. Out of total 110 cases, 52 (47.27%) cases fulfilled WHO criteria while 58 (52.73%) cases fulfilled SA criteria. Total 9 cases were HIV positive, 3 cases were of WHO group while 6 cases were in SA group. Sensitivity of WHO and South African criteria was 33.33% and 66.67% respectively. Although South African criteria seemed to be more accurate as it was less subjective and its seropositivity rate was higher than that of WHO criteria (10.34% vs 5.77%), it was not found to be statistically significant (p > 0.05) in our setup.