Current trends in opportunistic infections in children living with HIV/AIDS in a tertiary care hospital in Northern India.

Abstract

Introduction:A prospective cohort study was undertaken from November 2010 to March 2012 at Kalawati Saran Children's Hospital (KSCH), Lady Hardinge Medical College (LHMC), New Delhi. The study included all HIV positive children aged between 0-15 years that were registered in the anti-retroviral therapy (ART) centre during the study period. HIV +ve children enrolled at the ART centre were started on ART on the basis of CD4counts (National/NACO guidelines).Materials and Methods:Various samples were collected from the patients depending on their presenting complaints as per the standard protocols. These included stool, sputum, gastric aspirate, urine, blood, pus and CSF. All the samples were processed in the microbiology laboratory as per the standard techniques. Majority of children presented to the hospital with respiratory system involvement. Fever with cough was the presenting symptom in around half of all the children suggesting involvement of upper and/or lower respiratory tract. Diarrhea and protein energy malnutrition (PEM) were the next most common findings. Clinical presentations more suggestive of HIV (e.g. generalized lymphadenopathy, mucocutaneous lesions, oral thrush etc.) were less commonly the presenting complaints.Results:OIs are still a major health hazard in children living with HIV/AIDS. The pattern of OIs encountered in a developing country like ours is different from the pattern observed in western countries. Tuberculosis is still a major problem as well as other bacterial infections. Fungal and parasitic infections are also a common health hazard. ART is a major pillar for combat against this dreadful disease. As suggested by our study, timely initiation of ART leads to an increase in CD4+ counts which is imperative in protection against OIs in HIV infected patients. Hence, routine monitoring of CD4+ counts and timely initiation and continuation of ART should be a major event in the life of a child infected with HIV.