HIV-seropositive Children Research Articles

Fertility desire and associated factors among women of reproductive age living with HIV/AIDS attending antiretroviral therapy clinic in Arba Minch General Hospital, South Ethiopia, 2021.

The fertility desire of women living with HIV to have children can have significant implications for public health. Despite the increase in the number of HIV-positive women, the issues of their fertility desire have not been well-studied. This study aims to assess fertility desire and associated factors among women living with HIV/AIDS. A facility-based cross-sectional study was conducted from 1 May to 30 July 2021. The researchers employed a systematic sampling technique. The data were gathered and entered into EpiData 3.1 software, and subsequently exported to the statistical package for social science version 25 for analysis. Binary logistic regression analyses were used to identify the factors involved, and a p-value of <0.05 at a 95% confidence level was deemed to be statistically significant. The findings of this study indicate that 47.8% of women expressed a desire to conceive. Various factors such as parents' pressure [adjusted odds ratio (AOR) = 4.41, 95% confidence interval (CI): 2.15-9.05], community pressure (AOR = 2.62, 95% CI: 1.30-5.26), being married (AOR = 0.25, 95% CI: 0.09-0.73), having only female offspring (AOR = 2.57, 95% CI: 1.12-5.90), and having HIV seropositive children (AOR = 2.45, 95% CI: 1.23-4.85) had statistically significant association with fertility desire. The study area exhibited a high level of fertility desire. Various factors can influence fertility desire, including parents' pressure, community pressure, being married, having only female offspring, and having children who are HIV seropositive. When developing interventions on sexual and reproductive health issues, it is imperative for policymakers and healthcare providers who are working in antiretroviral therapy clinics to take into account the effects of these factors on women living with HIV. When designing and implementing prevention of mother-to-child transmission services, it is important to consider the fertility desires of mothers who are living with HIV.

Dermatological manifestations during HIV infection in children in Dakar, Senegal

Background: Dermatological manifestations are frequent and often constitute a circumstance of HIV discovery in 70% of cases [1]. They are observed in 83% of patients with AIDS and at an early stage in 75% [2,3,4,5]. The objective of this study was to describe the epidemiological, clinical, therapeutic, and evolutionary aspects of skin manifestations during HIV infection in children. Materials and Methods: We conducted a cross-sectional, multicentric, descriptive study over a period of ten years in two dermatology departments and one pediatric department in Dakar, Senegal. We included all HIV-seropositive children aged 0–15 years with mucosal cutaneous manifestations. A dermatologist and a specialist in the medical care of HIV performed the diagnosis of cutaneous manifestations. Data entry and analysis were performed with the SPSS software, version 9.05. Results: We collected 206 cases of cutaneous manifestations in 454 children followed for HIV infection. The hospital frequency was 45.3%. The children were male in 115 cases (55.83%) and female in 91 cases (44.17%), giving a sex ratio of 1.26. The mean age of the patients was sixty months, with extremes of one month to fourteen years. A mycotic dermatosis origin was noted in 47.37%, ringworm in 22.37%, dermatophytosis in 8.58%, oral candidiasis in 6.58%, seborrheic dermatitis in 6.58%, and perleche in 3.29%. Bacterial skin diseases were represented by furunculosis in 1.97%, and impetigo in 7.24%. Viral dermatoses included molluscum contagiosum in 10.53%, shingles in 9.21%, warts in 9.87%, and chickenpox in 3.95%. As for parasitic dermatoses, scabies was noted in 8.55, followed by larva migrans in 0.66% and cutaneous leishmaniosis in 0.66%. Immuno-allergic dermatoses accounted for 25% and included prurigo in 94.3%, atopic dermatitis in 1.90%, and fixed pigmented erythema in 1.90%. Conclusion: Cutaneous manifestations are a common discovery during HIV infection in children. They are marked by a predominance of infectious dermatoses in sub-Saharan Africa. Key words: skin diseases; HIV; children; Dakar

Prevalence of alexithymia among a cohort of well controlled HIV-infected adolescents and non-HIV-infected adolescents

Background: With the introduction of highly active antiretroviral therapy (HAART) in 1996, the quality of life of people living with HIV has improved. Although people diagnosed and living with HIV are overwhelmed by emotions, we found that various emotional manifestations are understudied within this group of patients. One such aspect is alexithymia which is seen at exorbitantly high rates among patients with depression, causing a major public health concern. In our study, we hypothesized that clinically significant changes with HAART would be associated with changes in depression, anxiety, and alexithymia. Materials and Methods: A cross-sectional study was conducted with a convenient sample of 44 HIV-seropositive children and 30 healthy school children of age 12–15 years. We obtained permission from participants to access their medical records to obtain data regarding their CD4 cell counts and viral loads over the entire study period. The enrolled participants were administered a validated 20-item Toronto alexithymia scale (TAS-20) to assess their alexithymic levels. Results: Mean alexithymia score of healthy children was 0.67 ± 1.26 and mean of children living with HIV was 4.48 ± 7.80. When comparing the TAS-20 scores of children living with HIV and healthy children, children living with HIV revealed scores slightly higher than healthy children, but none showed scores equal to 40. There was statistically significant difference between both groups (P = 0.003). Conclusion: Our study revealed that there was a significant difference between the TAS scores of HIV-seropositive children on HAART and healthy children, none of their scores indicated alexithymic condition. In the health sector, alexithymia has been emphasized as barriers to patient-practitioner communication. Clinicians should be aware of the decrease in alexithymic traits among HIV subjects who are under HAART. This study highlights the benefits of the HAART era, namely the chronicity of the infection and the possibility of disease management, thus improving the mental status of such population.

Maternal HIV does not affect resiliency among uninfected/HIV exposed South African children from birth to 5 years of age.

Examine resiliency among a South African population cohort of children of mothers living with HIV (MLH) and mothers without HIV (MWOH) in low-income townships over the first 5 years of life. A cluster randomized controlled intervention trial evaluating child resiliency and the effects of home visiting in township neighborhoods from pregnancy through 5 years postbirth. The population of pregnant women in 24 matched neighborhoods were recruited and randomized by neighborhood to a standard care condition (n = 594) or a paraprofessional home visiting intervention condition (n = 644). Mothers and children were assessed at 2 weeks, 6, 18, 36, and 60 months postbirth (92-84% follow-up; 10.2% mortality). Resilient children were identified based on consistently meeting global standards for growth, cognitive functioning, and behavior. Maternal HIV status (n = 354 MLH; n = 723 mothers without HIV MWOH), intervention condition, maternal risks, caretaking, sociodemographic characteristics, and neighborhood were examined as predictors of child resiliency over time using analysis of variance, chi-square analyses, and Fisher's exact tests, where appropriate. None of HIV-seropositive children (n = 17) were resilient; 19% of 345 HIV-exposed but uninfected children of MLH were resilient, a rate very similar to the 16% among MWOH. Resiliency was significantly associated with lower income, food security, not having a live-in partner, and the absence of maternal risk (i.e., not being depressed, using alcohol, or being a victim of intimate partner violence). Being randomized to a home visiting intervention, maternal breastfeeding for at least 3 months and attending a preschool crèche were also unrelated to resiliency. Although matched pairs of neighborhoods had similar rates of resilient children, resiliency varied significantly by neighborhood with rates ranging from 9.5 to 27%. We set a new standard to define resiliency, as consistently recommended by theoreticians. Although seropositive children are not resilient, uninfected children of MLH are as resilient as their peers of MWOH. Typical protective factors (e.g., home visiting, breastfeeding, preschool) were unrelated to resiliency over the first 5 years of life. ClinicalTrials.gov registration #NCT00996528.

Disclosure to HIV-seropositive children in rural Zambia

BackgroundCare of children living with HIV comprises various issues, some considered challenging. One of the challenging areas is the serostatus disclosure to HIV-positive children. This study describes the current situation of HIV disclosure among rural children in Zambia and examines the socio-demographic factors promoting disclosure.MethodsWe used a mixed method approach applying both quantitative and qualitative methods to obtain comprehensive picture of HIV serostatus disclosure for children. Data were collected in Mumbwa district, Zambia (2010–2012), included 57 clinical records of children older than 5 years old. We examined children’s age, gender, and cohabitation status with their parents, caregivers’ level of education and income, and the relation between children and caregivers. Logistic regression model was applied to examine associations between disclosure and socio-demographic characteristics. Semi-structured interviews with 50 caregivers and 22 HIV-positive children were conducted to qualitatively investigate attitude towards disclosure and support needed.ResultsFull disclosure was completed in 17 out of 57 (29.8%) patients. Median ages of patients in disclosed group and non-disclosed group were 10 and 9, respectively (IQR 8.0–13.0, 7.0–11.25). In univariate analyses, older age and male gender has positive relation to the completion of serostatus disclosure. In logistic regression models, cohabitation status with patients’ mothers showed positive correlation to the completion of serostatus disclosure. In the interviews with caregivers, all caregivers said that disclosure of serostatus is a necessary process and good for their children, while actual serostatus disclosure rate was low.ConclusionSerostatus disclosure to HIV-seropositive children is not prevalent in Rural Zambia. Although further researches would be desirable, increased support to caregivers would be beneficial.

Clinical spectrum of paediatric HIV infection in a tertiary care centre in South India

Background: The global burden of paediatric HIV and acquired immune deficiency syndrome (AIDS) remains a challenge for healthcare workers around the world, particularly in developing countries. The objective of this study is to describe the spectrum of HIV infection in children including the mode of transmission, clinical manifestations and opportunistic infections associated with HIV infection.Methods: Confirmed HIV seropositive children aged between 18 months to 19 years admitted to paediatric ward of JSS hospital, Mysore during two-year period were enrolled in this prospective observational study. Detailed history, socio-demographic characteristics and clinical manifestations were recorded in the predesigned performa. Nutritional assessment, complete physical, systemic and neurological examination was performed at the time of admission and was supplemented with ancillary investigations. Patients were correlated with modified WHO clinical case definition for AIDS and categorized as per revised CDC NABC classification of pediatric HIV infection.Results: Forty HIV-infected children were enrolled: with mean age of 4.5 years. Vertical transmission was the predominant mode of HIV transmission (97.5%). Most of the children were severely symptomatic belonging to category-C of NABC classification. Common clinical manifestations noted were failure to thrive (45%), recurrent respiratory infections (42%), bacterial skin infection (36%), recurrent otitis (42.5%), papulo-pruritic dermatitis (22%), hepatosplenomegaly (85%), lymphadenopathy (45%) and HIV encephalopathy (52%). The common opportunistic infections observed were pulmonary tuberculosis (45%), recurrent diarrhoea (35%), oral candidiasis (30%). The rare presentations of HIV noted were chronic thrombocytopenia and a case of dilated cardiomyopathy.Conclusions: Vertical transmission was the major route of HIV infection. HIV encephalopathy was more common among severely affected children. Tuberculosis was the commonest opportunistic infection.

Attrition among HIV positive children enrolled under integrated HIV care programme in Myanmar: 12 years cohort analysis

ABSTRACTBackground: In Myanmar, HIV seropositive children are being enrolled in an integrated HIV care (IHC) Program for HIV treatment and care since 2005.Objectives: To assess the: (a) attrition (death or loss-to-follow-up) rates among children (aged ≥ 18 months to < 15 years) enrolled into the programme before and after initiation of anti-retroviral therapy (ART) (pre-ART and ART periods); (b) demographic and clinical factors associated with attrition during these two periods.Methods: Children enrolled in IHC Programme and their status (death, lost to follow-up, regular follow-up or transferred out) was assessed as on 30 June 2017. Attrition rates (per 100 person-years) at pre – ART and ART periods were calculated and the association between demographic and clinical characteristics with attrition was assessed using Cox proportional hazards model.Results: Among 2,736 children enrolled, pre-ART attrition rate was 19 per 100 person-years of follow-up (95% CI: 17–21) and ART attrition rate was 4 per 100 person-years of follow-up (95% CI: 3–4) with higher levels during the initial few months of enrolment. The 36-month retention rates during pre-ART period was 75% (95% CI: 72–78) and during ART period was 87% (95% CI: 86–88). The children ‘at enrolment’ with relatively lower levels of haemoglobin, immune deficiency, underweight for age, higher WHO clinical stages, presence of hepatitis B infection had higher hazards of attrition in both periods.Conclusion: The attrition rates are high particularly among children with relatively poorer clinical, nutritional profiles at enrolment. The study suggests the urgent need for improving adherence counselling especially during the initial few months of enrolment and early ART initiation.

Effectiveness of WHO's pragmatic screening algorithm for child contacts of tuberculosis cases in resource-constrained settings: a prospective cohort study in Uganda

Tuberculosis is a leading cause of global childhood mortality; however, interventions to detect undiagnosed tuberculosis in children are underused. Child contact tracing has been widely recommended but poorly implemented in resource-constrained settings. WHO has proposed a pragmatic screening approach for managing child contacts. We assessed the effectiveness of this screening approach and alternative symptom-based algorithms in identifying secondary tuberculosis in a prospectively followed cohort of Ugandan child contacts. We identified index patients aged at least 18 years with microbiologically confirmed pulmonary tuberculosis at Old Mulago Hospital (Kampala, Uganda) between Oct 1, 1995, and Dec 31, 2008. Households of index patients were visited by fieldworkers within 2 weeks of diagnosis. Coprevalent and incident tuberculosis were assessed in household contacts through clinical, radiographical, and microbiological examinations for 2 years. Disease rates were compared among children younger than 16 years with and without symptoms included in the WHO pragmatic guideline (presence of haemoptysis, fever, chronic cough, weight loss, night sweats, and poor appetite). Symptoms could be of any duration, except cough (>21 days) and fever (>14 days). A modified WHO decision-tree designed to detect high-risk asymptomatic child contacts was also assessed, in which all asymptomatic contacts were classified as high risk (children younger than 3 years or immunocompromised [HIV-infected]) or low risk (aged 3 years or older and immunocompetent [HIV-negative]). We also assessed a more restrictive algorithm (ie, assessing only children with presence of chronic cough and one other tuberculosis-related symptom). Of 1718 household child contacts, 126 (7%) had coprevalent tuberculosis and 24 (1%) developed incident tuberculosis, diagnosed over the 2-year study period. Of these 150 cases of tuberculosis, 95 (63%) were microbiologically confirmed with a positive sputum culture. Using the WHO approach, 364 (21%) of 1718 child contacts had at least one tuberculosis-related symptom and 85 (23%) were identified as having coprevalent tuberculosis, 67% of all coprevalent cases detected (diagnostic odds ratio 9·8, 95% CI 6·8-14·5; p<0·0001). 1354 (79%) of 1718 child contacts had no symptoms, of whom 41 (3%) had coprevalent tuberculosis. The WHO approach was effective in contacts younger than 5 years: 70 (33%) of 211 symptomatic contacts had coprevalent disease compared with 23 (6%) of 367 asymptomatic contacts (p<0·0001). This approach was also effective in contacts aged 5 years and older: 15 (10%) of 153 symptomatic contacts had coprevalent disease compared with 18 (2%) of 987 asymptomatic contacts (p<0·0001). More coprevalent disease was detected in child contacts recommended for screening when the study population was restricted by HIV-serostatus (11 [48%] of 23 symptomatic HIV-seropositive child contacts vs two [7%] of 31 asymptomatic HIV-seropositive child contacts) or to only culture-confirmed cases (47 [13%] culture confirmed cases of 364 symptomatic child contacts vs 29 [2%] culture confirmed cases of 1354 asymptomatic child contacts). In the modified algorithm, high-risk asymptomatic child contacts were at increased risk for coprevalent disease versus low-risk asymptomatic contacts (14 [6%] of 224 vs 27 [2%] of 1130; p=0·0021). The presence of tuberculosis infection did not predict incident disease in either symptomatic or asymptomatic child contacts: in symptomatic contacts, eight (5%) of 169 infected contacts and six (5%) of 111 uninfected contacts developed incident tuberculosis (p=0·80). Among asymptomatic contacts, incident tuberculosis occurred in six (<1%) of 795 contacts infected at baseline versus four (<1%) of 518 contacts uninfected at baseline, respectively (p=1·00). WHO's pragmatic, symptom-based algorithm was an effective case-finding tool, especially in children younger than 5 years. A modified decision-tree identified 6% of asymptomatic child contacts at high risk for subclinical disease. Increasing the feasibility of child-contact tracing using these approaches should be encouraged to decrease tuberculosis-related paediatric mortality in high-burden settings, but this should be partnered with increasing access to microbiological point-of-care testing. National Institutes of Health, Tuberculosis Research Unit, AIDS International Training and Research Program of the Fogarty International Center, and the Center for AIDS Research.

Biochemical Modifications in HIV-Infected Children and Adolescents Under Antiretroviral Therapy

In this paper we propose to present the biochemical modifications in children and adolescents with HIV infection/AIDS undergoing antiretroviral therapy (ART). We have carried out a retrospective study on 200 HIV-seropositive children registered in our department, without any prior workup modifications, in which antiretroviral therapy was initiated. In all patients we have monitored serum glucose, amylasemia, natremia, and liver enzymes. Most of the biochemical modifications were mild and moderate and did not necessitate cessation of therapy. In only 2 cases, modifications were severe enough to impose a temporary interruption of the ART: one case with elevated triglycerides and one case with elevated liver enzymes. After 24 months of ART, approximately 11.5% (23/200) of the monitored patients had biochemical modifications: 3.5 % elevated triglycerides, 5% elevated liver enzymes, 2.5 % hyperamylasemia, and 0.5 % hypernatremia. Biochemical modifications were more significant in patients who received prior antiretroviral therapy, particularly those who received protease inhibitors (PIs) in comparison to patients naive to ART.

Lipd Metabolism Abnormalities in Children and Adolescents with HIV/AIDS Treated with Protease Inhibitors

In this paper we propose to evaluate the lipid metabolism abnormalities in children and adolescents with HIV/AIDS undergoing treatment with protease inhibitors (PIs). There are over 1000 children and adolescents with HIV infection of various stages registered in the Pediatric Department of the National Institute of Infectious Diseases Prof. Dr. Matei Bals. We have carried out a retrospective study on 200 HIV seropositive children without previous lipid metabolism abnormalities in which antiretroviral treatment was initiated. In these patients we have monitored modifications in lipid metabolism secondary to antiretroviral treatment (triglycerides, cholesterol, and lipids). The majorities of abnormalities of the lipid metabolism were not severe and did not require modification or cessation of treatment. 24 months of treatment later, approximately 23.5% of patients treated with 2 NRTI+PI/r had modifications of the lipid metabolism: 34.6% had hypercholesterolemia, 38.4% had hypertriglyceridemia, and 36.9% had an increase of total serum lipids. Lipid metabolism abnormalities have been more significant in patients treated previously with antiretrovirals, especially those who have received PIs, in comparison to na�ve patients.

Is salivary IgA level a potential biomarker for immunosuppression in HIV-positive children? A systematic review and meta-analysis.

The aim of this systematic review was to determine whether or not assessment of salivary secretory immunoglobulin A (sIgA) levels could be a potential biomarker for immunosuppression in HIV-positive children. The Patient, Exposure, Comparative, Outcome question was "Is sIgA level a potential biomarker for immunosuppression in HIV-positive children?" Electronic and manual literature searches were conducted in indexed databases (MEDLINE, PubMed, EMBASE, ScienceDirect, and SCOPUS databases) up to and including June 2017. The primary outcome was total mean salivary levels of IgA among HIV seropositive and seronegative children (controls). The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for total mean salivary IgA levels were calculated using a random effect model. Six studies were included. Three studies showed significantly lower salivary IgA levels in HIV-infected children compared with controls. Two studies showed comparable IgA levels in HIV infected and controls. One study showed significantly higher levels of salivary IgA in HIV-infected children as compared to controls. Considering the total mean salivary IgA levels among HIV seropositive and seronegative children, a high degree of heterogeneity (Q value=254.09, P<.0001, I2 =98.82%) was noticed among both groups. The overall WMD was not significant (WMD=-1.18, 95% CI, -1.91 to -0.44, P=.39). Whether salivary IgA level is a potential biomarker for immunosuppression in HIV-positive children remains debatable because of limited information available in the current literature. Further, high-quality case-control studies with larger sample size and more solid methodological aspects are required.

A Growth and Nutritional Study of HIV Seropositive Children from West Bengal under Direct Care of Medical Caregivers.

To evaluate the nutritional status of HIV seropositive children, aged 2-10 years with age - matched controls and examine the role of nutritional intervention and HRT on their growth indices. It was a cross-sectional study done at a HIV Clinic of a teaching hospital. Fifty six seropositive children (age 2-10 year) classified as cases, and 60 seronegative age - matched controls were taken. Demographic and anthropometric characteristics were collected via valid instruments. HIV grading and adherence to HRT were assessed by using validated questionnaires. Of the cases majority (87.5%) were infected by vertical transmission from mother to child, the remaining were infected by blood transfusion out of which 1.78% were haemophiliacs and remaining were thalassaemics. The prevalence of underweight among cases was 64.3%, compared to prevalence of 61% among controls. The prevalence of stunting was 44.6% among cases, while the prevalence of severe stunting was 14.3%. The prevalence of wasting among cases was 30.35%, while 7% cases were severely wasted. Only 23.33% controls were wasted. There was a significant difference in the Height- for-age between cases and controls, in the age of 4 years, 5 years and 6 years (p-value <0.05). There was a significant difference in the Height- for-age between cases and controls, in the age of 4 years, 5 years and 6 years, indicating the need for proper nutritional intervention and timely HIV antiretroviral therapy to prevent stunting.

Kaposi sarcoma in HIV-seronegative children presenting to the paediatric oncology ward in The Queen Elizabeth Central Hospital, Blantyre, Malawi during 2002-2014.

One of the most common malignancies in HIV-endemic, resource-poor countries is Kaposi sarcoma (KS). It is an AIDS-defining disease and as Malawi's incidence and prevalence of HIV is high, KS is now the most common cancer in adult male Malawians and the second most common in women and children. Most attention has focused on HIV-seropositive adults as their number far outweighs those of children. This audit concerns the presentation and outcome of HIV-seronegative children with KS who presented in a 12-year period (2002-2014) to The Queen Elizabeth Central Hospital. Twenty (10.5%) of the 191 children with KS presenting to the paediatric oncology ward during 2002-2014 were HIV-seronegative. They were usually younger than seropositive children and 62% had severe anaemia. The main presenting complaints in the HIV-seronegative group were woody oedema, commonly of a limb, and lymphadenopathy. Woody oedema was common in children with or without HIV infection. Seronegative children with KS were less likely to have oral KS than HIV infected children. Of 11 children who completed courses of chemotherapy, seven (63%) had complete cure sustained over a 1-year follow-up period. KS is potentially curable in this group of children. Chemotherapy regimens are equally effective in HIV-seropositive and HIV-seronegative children. The presentation of HIV-seronegative children with KS differs from adults and HIV-seropositive children. Further research is necessary to determine possible triggers for developing KS in HIV-seronegative children.

Effects in the adherence treatment and psychological adjustment after the disclosure of HIV/AIDS diagnosis with the "DIRE" clinical model in Colombian children under 17

A study in five Colombian cities in 2006, confirms the findings of other international studies: the majority of HIV-positive children not know their diagnosis, caregivers are reluctant to give this information because they believe that the news will cause emotional distress to the child becoming primary purpose of this study to validate a model of revelation. We implemented a clinical model, referred to as: "DIRE" that hypothetically had normalizing effects on psychological adjustment and adherence to antiretroviral treatment of HIV seropositive children, using a quasi-experimental design. Test were administered (questionnaire to assess patterns of disclosure and non-disclosure of the diagnosis of VIH/SIDA on children in health professionals and participants caregivers, Family Apgar, EuroQol EQ- 5D, MOS Social Support Survey Questionnaire Information treatment for VIH/SIDA and child Symptom Checklist CBCL/6-18 adapted to Latinos) before and after implementation of the model to 31 children (n: 31), 30 caregivers (n: 30) and 41 health professionals. Data processing was performed using the Statistical Package for the Social Science version 21 by applying parametric tests (Friedman) and nonparametric (t Student). No significant differences in adherence to treatment (p=0.392), in the psychological adjustment were found positive significant differences at follow-ups compared to baseline 2 weeks (p: 0.001), 3 months (p: 0.000) and 6 months (p: 0.000). The clinical model demonstrated effectiveness in normalizing of psychological adjustment and maintaining treatment compliance. The process also generated confidence in caregivers and health professionals in this difficult task.

Respiratory Tract Infections in Children Infected with HIV/AIDS in Minna, Niger State, Nigeria

Children with HIV/AIDS compared to immune competent ones develop respiratory tract infections in a pattern that are different in nature, severity and/or frequency. 50 children with laboratory confirmed HIV inf ection and 80 children with laboratory confirmation of HIV negative status were included in this study. Their ages ranged from 6 years to 14 years. All the patients were from urban areas. The study was aimed at determine the spectrum of bacterial agent tha t causes respiratory tract infection among HIV infected children as well as HIV uninfected children in Minna, Niger State and comparing the prevalence rate within different range of CD4 count. Sputum culture was taken to determine the profile of bacterial infection. All isolates from the cultures were identified using microbact identification kit (source: Oxoid Limited, United Kingdom). The frequency of bacteria isolates from HIV seropositive children was higher than the pneumoniae isolates from HIV Sero negative Streptococcus pneumoniae 15(89%) and Klebsiella pneumonia 20(89%) was the most common Gram - positive and Gram - negative bacteria identified respectively. 30% of the studied children were positive for at least one pathogenic bacterium. There was no significant difference between the prevalence rate of respiratory tract infection among HIV infected children and Original Research Article

Prevalence and Clinico-Demographic Characteristics Associated with Bacterial Diarrhea among HIV Positive and Negative Children Aged Below Five Years at Moi Teaching and Referral Hospital, Kenya

Diarrhea is the second leading cause of morbidity and mortality worldwide. It accounts for over 2 million deaths in children aged below 5 years, majority being from Sub-Saharan Africa. Diarrhea is ranked third as a cause of death and the third leading cause of pediatric admissions in Kenya. The objective of this study was to determine the prevalence and clinico-demographic characteristics associated with diarrhea in relation to patient HIV status. This was a cross- sectional comparative study of 216 HIV seropositive and seronegative children aged below 5 years admitted with diarrhea at Moi Teaching and Referral Hospital in Western Kenya. Clinico-demographic characteristics associated with diarrhea were obtained using questionnaires. Stool samples were collected and analyzed using standard microbiological methods to determine their bacterial etiology. The mean (standard deviation) 24.11(15.61) vs. 11.77(7.88), median and inter quartile range 22(10, 36) vs. 10 (6, 16) was higher among HIV positive than negative cases with no statistically significant differences with regard to gender. The prevalence of diarrhea was 17.1% with 64.4% (139) of our cases being male and 35.6% (77) female. The prevalence of bacterial and non bacterial diarrhea was 8.5% (118) and 7.1% (98) respectively. The main bacterial enteropathogens isolated among HIV positive and negative cases were Escherichia coli 88.9 % (38 vs. 67) , Shigella 5.1 %( 1, 5), Salmonella 4.2% (0, 5) and other enteric species 1.7% (0, 2). EAEC (17.7%) was the main diarrheagenic E coli (DEC) followed by EHEC (5.1%), EPEC (3.4%), EIEC (2.5%) and ETEC (1.7%). Other were S.typhimurium 4.2% (0, 5), S.typhi 3.4 %) (0, 4), S. dyenteriae and S. flexneri 2.5% (0, 3) each respectively. HIV positive individuals recorded more mixed infections (72% vs. 28%) than HIV negative cases. Some of illnesses recorded in HIV positive cases included tuberculosis 4(100%) and meningitis 8(100%) whereas pneumonia 21(71.4 % vs. 28.6), oral thrush 13 (76.9% vs. 23.1%), malaria 19 (57.9% vs. 42.1%) and protein energy malnutrition 13 (61.5% vs. 38.5 %) were recorded in both HIV positive and negative cases respectively. Education level of parent/guardian, socioeconomic status, housing, water, sanitation and seasonal variations were significantly associated with diarrhea. The study depicts a positive correlation between clinico-demographic characteristics and HIV status on prevalence and etiology of diarrhea. We recommend improved hygienic practices, definitive diagnosis of diarrhea etiology and patient HIV status for effective management of childhood diarrhea.

Follow-Up of Post-Discharge Growth and Mortality after Treatment for Severe Acute Malnutrition (FuSAM Study): A Prospective Cohort Study

BackgroundManagement of Severe Acute Malnutrition (SAM) plays a vital role in achieving global child survival targets. Effective treatment programmes are available but little is known about longer term outcomes following programme discharge.MethodsFrom July 2006 to March 2007, 1024 children (median age 21.5 months, IQR 15–32) contributed 1187 admission episodes to an inpatient-based SAM treatment centre in Blantyre, Malawi. Long term outcomes, were determined in a longitudinal cohort study, a year or more after initial programme discharge. We found information on 88%(899/1024).ResultsIn total, 42%(427/1024) children died during or after treatment. 25%(105/427) of deaths occurred after normal programme discharge, >90 days after admission. Mortality was greatest among HIV seropositive children: 62%(274/445). Other risk factors included age <12 months; severity of malnutrition at admission; and disability. In survivors, weight-for-height and weight-for-age improved but height-for-age remained low, mean −2.97 z-scores (SD 1.3).ConclusionsAlthough SAM mortality in this setting was unacceptably high, our findings offer important lessons for future programming, policy and research. First is the need for improved programme evaluation: most routine reporting systems would have missed late deaths and underestimated total mortality due to SAM. Second, a more holistic view of SAM is needed: while treatment will always focus on nutritional interventions, it is vital to also identify and manage underlying clinical conditions such as HIV and disability. Finally early identification and treatment of SAM should be emphasised: our results suggest that this could improve longer term as well as short term outcomes. As international policy and programming becomes increasingly focused on stunting and post-malnutrition chronic disease outcomes, SAM should not be forgotten. Proactive prevention and treatment services are essential, not only to reduce mortality in the short term but also because they have potential to impact on longer term morbidity, growth and development of survivors.

Hear our voices: A Photovoice project with children who are orphaned and living with HIV in a Ugandan group home

In June 2010, we conducted a qualitative participatory research study to explore the experience of orphaned, HIV seropositive children who live in a group home in semi-urban western Uganda. Photovoice was used as a participatory method to enhance storytelling with children between 12 and 18years (n=5 girls; n=8 boys). In previous project work done by the research team in Uganda, children's affirming experiences in their group home suggested an extension to the dominant view that favors extended family placements, and raises the need for further inquiry regarding institutional care. Children in this study revealed how the group home supported key protective factors in their everyday lives that promote well-being, and resilience for coping with challenges such as stigma. Children expressed how their group home fostered a sense of belonging and appreciation for nature, home, resources and community. Children also described their hardships stemming from stigma, including associated psychological, emotional and social challenges. This forces us to re-think the role of institutional care for orphaned children who are HIV seropositive, guided by the unique perspective of children themselves. This research extends our understanding of key protective factors, while also challenging the dominant view to include institutional care as an effective placement option for those that require specialized care and support. Moreover, findings demonstrate that HIV seropositive orphaned children who live in a group home setting experience protective factors supporting their psychological, emotional and social well-being.

Serum zinc levels in HIV infected children attending the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

Background: Zinc deficiency is common in the Paediatric age group but the extent of this disorder is unknown in HIV infected children in Nigeria prompting this study. Objective : To determine the prevalence of zinc deficiency in HIV seropositive children, and compare this with age and sex matched controls. Methods : A case control study of 70 HIV sero-positive and age and sex matched HIV sero-negative children was carried out in the University of Port Harcourt Teaching Hospital between 1st of June, 2009 and 31st of May, 2010. We collected demographic, clinical, haematological and biochemical parameters from cases and controls, and analysed these using SPSS 20. Results : Sixty percent of the subjects were zinc deficient as against 41.4% of the controls, p= 0.028. Subjects that were zinc deficient were more likely to be in higher HIV disease stages, p = 0.003, in lower socio-economic classes and aged less than 60 months. We conclude that there is a high prevalence of zinc deficiency in HIV sero-positive children and they should have zinc supplementation immediately they are diagnosed to reduce their morbidity and mortality. Key words : Zinc deficiency, HIV sero-positive, socio-economic status

Prevalence of Oral and Systemic Manifestations in Pediatric HIV Cohorts with and without Drug Therapy

The prevalence of orofacial and systemic manifestations and their association with drug therapy in pediatric HIV patients is scarce in the literature. The aim of the study was to determine the prevalence of oro-facial and systemic manifestations in HIV sero-positive children with and without highly active antiretroviral therapy (HAART). The study population consisted of 100 pediatric HIV patients (n=47 on HAART and n=53 not on HAART). The majority of the children (n=56) had at least one or more oro-facial manifestation associated with HIV. Oral candidiasis was the most common oral finding present in the HAART (14/33) and non-HAART groups (19/33). Recurrent aphthous ulcers was the only significant oral finding, present more in the HAART group. The percentage of children with upper respiratory tract infection was also more in the HAART group. The other lesions which were found to be significant were seborrheic dermatitis, pulmonary tuberculosis and otitis media. There was no significant difference in the participants' oral findings based on CD4 counts in the HAART and non- HAART groups. The prevalence of oral and systemic manifestations is a persistent feature associated with pediatric HIV, though of moderate intensity in those using HAART and may vary according to individual immune status.