Papular pruritic eruptions: A marker of progressive HIV disease in children: Experience from eastern India

Abstract

Papular pruritic eruptions (PPEs) are a commonly seen dermatological manifestation in children with Human Immunodeficiency Virus (HIV) stage 2 disease, whereas recurrent upper respiratory tract infection (URTI) (<2 episodes in 6 months) is the most common presenting illness in this category. Papular pruritic eruptions has been associated with progressive HIV disease in adults though it is categorized in early stage. To evaluate PPE as a clinical marker for progressive pediatric HIV. In Pediatric HIV/AIDS clinic, Medical College, Kolkata, a prospective longitudinal hospital-based observational study was carried out. A total of 108 children in WHO stage 2 HIV disease aged between 2 and 12 years were selected, of which 58 had recurrent URTI without PPE and another 50 had PPE with or without secondary bacterial infection. Clinico-immunological deterioration was compared between the groups in terms of progression to undernutrition, WHO clinical stage 4 disease, severe immunodeficiency, need for initiation of Highly Active Anti Retroviral Therapy (HAART) and mortality over a period of 2 years. SPSS statistical software version 10 was used. P value, relative risk (RR) with 95% Confidence Interval (CI), sensitivity and specificity was estimated. P < 0.05 was considered significant. Significantly higher incidence (P < 0.001) of clinico-immunological progression of disease at a significantly shorter time period (P < 0.05) was found in those with PPE in comparison to those without PPE. Papular pruritic eruption has high sensitivity, specificity and positive predictive value as a clinical marker for severe immunodeficiency. Papular pruritic eruption could be a useful clinical marker of progressive HIV disease in children.