Human Immunodeficiency Virus Positive Children Research Articles

Invasive Infections for Endemic Fungi in Pediatrics in Guatemala

Background: Invasive fungal infections are common opportunistic diseases in patients with AIDS, other conditions related to immunodeficiency and healthy infants. Most publications on this subject are related to industrialized countries, and in adult population, with limited data in Latin America (except for Brazil, Colombia, and Argentina), and especially in pediatric population. These patients present a variety of clinical manifestations representing a diagnostic and therapeutic challenge for the health system. Objective: The objective of the study is to describe the epidemiological and laboratory characteristics of children with invasive fungal infections in Guatemala. Methods: A review of the microbiology service database was carried out at Roosevelt Hospital in Guatemala. Positive cultures were taken from children under 15 years of age, in a period of seven years, from 2007 to 2014, with its corresponding medical history. Results: Finally, 23 isolates were documented but only 15 patients were included in the study with complete information; 10 Histoplasma capsulatum cases, 4 Cryptococcus neoformans cases and 1 Coccidioidessp case. The average age was 7 years old for Histoplasma and 9 years old for Criptococo, with an age range from 6 months to 14 years. Around 60% of the patients were older than 5 years, of which, more than two-thirds were HIV positive children without antiretroviral therapy, who presented an invasive fungal infection at the time of HIV diagnosis. These infections are endemic in Guatemala, so the distribution was mostly uniform. Around 80% of the patients had some disease related to immunodeficiency and 70% were infected with human immunodeficiency virus (HIV). The microbiological isolation was from blood, bone marrow, lymph nodes, cerebrospinal fluid and urine. The predominant laboratory findings were decrease in hematological series. The most frequent clinical syndromes were fever, adenomegaly, hepatosplenomegaly, respiratory, gastrointestinal, neurological and weight loss. Mortality rate was 53% (from them, 62% were HIV positive). From these patients, an87% did not receive antifungal treatment in time due to late diagnosis of the infection. Conclusions: These infections should be considered when treating pediatric patients from tropical regions, with nonspecific systemic symptoms and signs, lymph node involvement and hematological alterations related to the mononuclear phagocytic system, mainly if they are patients infected by HIV in an advanced stage, infants, or children with a disease that weakens the immune system. When there is a high suspicion of a fungal infection, screening for HIV is mandatory; cultures should be taken early and together with rapid diagnostic tests. An antifungal treatment should be started immediately and then modified accordingly to laboratory results.

A study of neuropsychological profile of human immunodeficiency virus-positive children and adolescents on antiretroviral therapy.

Aims:The aim is to study the neuropsychological and functional profile of children and adolescents with human immunodeficiency virus (HIV) infection on antiretroviral therapy (ART) and the association between the neuropsychological status and medical illness variables, treatment variables, and functional status in the cases of the sample and compare with normal controls.Materials and Methods:Forty-two HIV-positive children and adolescents on ART were evaluated and compared with 40 matched controls not known to be HIV-positive. The tools used were the Wechsler Intelligence Scale for Children-III R for neuropsychological evaluation, the Brief Impairment Scale to assess functional impairment, and a semi-structured questionnaire to obtain other relevant details.Results:There were significant differences between the verbal, performance intelligence quotients (IQs), global IQ score, and several individual subtests between cases and controls. The HIV group was also found to have a significant functional impairment.Conclusion:Our findings show that HIV infection is associated with significant cognitive and functional impairment. The role of ART in these impairments requires further study. Such understanding can help to introduce wholesome and relatively safer management strategies for youngsters with HIV infection and improve their quality of life.

Prevalence of Asymptomatic Microalbuminuria in HIV Positive Children in India.

To study the prevalence of covert or early renal involvement among human immunodeficiency virus (HIV) positive children. A cross-sectional observational study was carried out on 250 HIV positive children (2-18 y) on follow-up in a tertiary care hospital from January 2014 through June 2015. Those who met the study criteria were evaluated for microalbuminuria and glomerular and tubular dysfunctions. Fifty-one out of two hundred fifty (20%) children were found to have microalbuminuria though none had any other evidence of renal dysfunction. The incidence of microalbuminuria in children on Anti Retroviral Therapy (ART) and those not on ART was 20% and 21% respectively. Neither was there any difference in those with a CD4 count ≤500/cu mm compared with those with counts >500/cu mm. However, the overall CD4 counts were significantly lower in children with microalbuminuria. Microalbuminuria was detected in 20% of asymptomatic HIV positive children suggesting early glomerular dysfunction and need for regular screening and follow-up.

Accessing antiretroviral therapy for children: Caregivers' voices

Despite efforts to scale up access to antiretroviral therapy (ART), particularly at primary health care (PHC) facilities, antiretroviral therapy (ART) continues to be out of reach formany human immunodeficiency virus (HIV)-positive children in sub-Saharan Africa. In resource limited settings decentralisation of ART is required to scale up access to essential medication. Traditionally, paediatric HIV care has been provided in tertiary care facilities which have better human and material resources, but limited accessibility in terms of distance for caregivers of HIV-positive children. The focus of this article is on the experiences of caregivers whilst accessing ART for HIV-positive children at PHC (decentralised care) facilities in Nelson Mandela Bay (NMB) in the Eastern Cape, South Africa. A qualitative, explorative, descriptive and contextual research design was used. The target population comprised caregivers of HIV-positive children. Data were collected by means of indepth individual interviews, which were thematically analysed. Guba's model was usedto ensure trustworthiness. Barriers to accessing ART at PHC clinics for HIV-positive children included personal issues, negative experiences, lack of support and finance, stigma and discrimination. The researchers recommend standardised programmes be developed and implemented in PHC clinics to assist in providing treatment, care and support for HIV positive children.

Mortality following snake bite envenomation by Bitis arietans in an HIV positive child

Snake bites occur commonly in the rural areas of South Africa. Hospitals where snake bites are uncommon should always have protocols on standby in the event of such cases presenting. This is the first reported case documenting the effect of human immunodeficiency virus (HIV) on snake bite in South African children.A case report and review of relevant information about the case was undertaken.We present a case of a 1-year-old child referred from a peripheral hospital following a snake bite to the left upper limb with a compartment syndrome and features of cytotoxic envenomation. The patient presented late with a wide area of necrotic skin on the arm requiring extensive debridement. The underlying muscle was not necrotic. Polyvalent antivenom (South African Institute of Medical Research Polyvalent Snakebite Antiserum) administration was delayed by 4 days after the snake bite. The patient was also diagnosed with HIV and a persistent thrombocytopenia possibly due to both HIV infection and the snake bite venom. Lower respiratory tract infections with subsequent overwhelming sepsis ultimately resulted in the child's death.The case highlights the challenge of treating a snake bite in a young child with HIV and the detrimental outcome of delayed treatment. A protocol is essential in the management of snake bites in all hospitals.Level IV, Case report.This case highlights the interaction of snake bite envenomation and HIV infection on thrombocytopenia.

English

Human immunodeficiency virus (HIV) may influence hepatitis C virus (HCV) disease through immunosuppression. The aim of this study was to determine the sero-prevalence of HCV in HIV sero-positive children in Lagos, Nigeria. 132 blood samples of children aged 1-15 years were collected at the HIV clinics of Lagos University Teaching Hospital (LUTH) and Lagos State University Teaching Hospital (LASUTH). Confirmatory analysis of HIV sero-status was done using enzyme-linked immunosorbent assay (ELISA) kit. All the 132 children recruited were HIV sero-positive. Serological assay for HCV was done on the 132 HIV sero-positive serum samples using ELISA technique. Assay procedures were carried out at the Virology Unit, College of Medicine, University of Lagos. Out of the 132 HIV sero-positive samples, 6 were positive for HCV with a prevalence of 4.54% with sex related prevalence of four (6.58%) males and two (2.82%) females, respectively. Zero prevalence was recorded between age groups 1-3 years while a sero-prevalence of 20% was found among age groups 12-15 years. The result of this study implies that HIV positive children are likely to be co-infected with HCV, thus re-affirming the role of this virus in concomitant HIV associated infection in children which may further complicate their immunocompromised state.    Key words: Human immunodeficiency virus (HIV), hepatitis C virus (HCV), enzyme-linked immunosorbent assay (ELISA), Lagos. &nbsp

Salivary IgA versus HIV and Dental Caries.

The inter-relationship of Human Immunodeficiency Virus (HIV) infection and dental caries as well as Salivary Immunoglobulin-A (S-IgA) level appear to remain under explored while a manual and electronic search of the literature was made. Hence, the present study was undertaken to assess the relationship of S-IgA and dental caries status in HIV positive children. The aim of this study was to find out the relationship of S-IgA antibody with dental caries by measuring the concentration of IgA in saliva of HIV positive and negative children and determine the dental caries status in HIV positive and HIV negative children, which may help in treatment planning and prevention of the same. A total of 28 HIV positive children aged between 6-14 years and 28 age matched HIV negative children were included in this study and both samples were randomly selected from the same Non-Governmental Organization (NGO). The HIV status of both these samples was confirmed from their medical records provided by the NGO. Only 2cc of unstimulated saliva was collected from both groups in special tubes coded numerically using the method described by Collins and Dawes and the samples were analyzed to measure the concentration of IgA using commercially available ELISA kit (DRG Diagnostics, Germany). Examination of dental caries was carried out according to WHO criteria (1997) using a flat mouth mirror and CPI probe. In HIV +ve group mean S-IgA level was calculated as 81.61 ± 6.20 μg/ml, mean DMFT was 3.86 ± 3.37, mean deft was 4.75 ± 2.86. In HIV -ve group mean S-IgA level was calculated as 145.57 ± 17.83μg/ml, mean DMFT was 2.54 ± 0.69, mean deft was 2.43 ± 2.01. Strong-ve correlation between S-IgA and DMFT (r = -0.781, t = 6.38, p < 0.001) and negative but Not Significant (N.S.) correlation (r = -0.19, t = 0.99, p > 0.05) between S-IgA and deft was found in HIV +ve group. Strong -ve correlation between S-IgA and DMFT (r = -0.655, t = 4.42, p < 0.001), S-IgA and deft (r = -0.942, t =14.32, p=<0.001) was found in HIV-ve group. This study suggests that the individuals who are suffering from IgA deficiency in general, are more susceptible to dental caries than normal individuals.

Assessment of nutritional status and the variables affecting the nutritional status of human immunodeficiency virus positive children in antiretroviral therapy centre of J. A. group of hospitals, Gajra Raja medical college, Gwalior, Madhya Pradesh, India

Background: HIV-infected children are undernourished; an improvement in their nutritional status may significantly decrease their morbidity. Thus, determining the etiology and temporal course of malnutrition in children with HIV infection will be important for early intervention and development of re-feeding regimens. This cross-sectional study describes the nutritional status and the variables affecting it, among the children made vulnerable by HIV/AIDS. The objective of this study was to assess the nutritional status of the HIV positive children, and to study the variables affecting the nutritional status of HIV positive children. Methods: The study involved 84 HIV positive children of 18 months - 18 years age group in the ART centre of J. A. group of hospital, Gajra Raja medical college, Gwalior, Madhya Pradesh. Anthropometric measurements, birth and maternal characteristics, socio-economic and immunization profile, past illness were recorded. Z-scores were generated using WHO standards as indicators of nutritional status and variables were assessed by suitable statistical test . Results: Prevalence of under nutrition is very high particularly moderate and severe stunting (76.19%), moderate and severe underweight (71.42%), and moderate and severe wasting (38.09%) in under five years HIV positive children. While low height for age was observed in 60.31%, low weight for age in 34.92%, and low BMI for age was recorded in 20.63%, in 6-18 years age group. Besides HIV status, other significant determinants of nutritional outcomes include child factors, birth related factors, maternal level factors, socio-economic and past history of illness. Conclusions: This study documents poor nutritional status among HIV positive children of 18 months-18 years age group. HIV is an independent and non-modifiable risk factor for poor nutritional outcomes in those who are already infected but an improvement in their nutritional status may significantly decrease their morbidity. Early pediatric HIV testing of exposed or at risk children, followed by appropriate health care for infected children with integration of other child survival interventions like immunization, community participation may improve their nutritional status and survival.

Epidemiology of children with acquired immune deficiency syndrome (stage 3): A referral hospital-based study in Iran.

Lack of recognition of human immunodeficiency virus (HIV) infection especially in children and delayed implementation of effective control programs makes HIV infection as a major cause for concern. Information on HIV epidemiology in Iran as well as other Islamic countries is limited. The aim of our study was to describe the clinical manifestation and laboratory finding of HIV infected children who were admitted to a referral Children Medical Center (CMC) in Tehran, Iran, during 11 years from January 2002 to January 2013. This was a retrospective study carried out over a period of 11 years. The records of all patients attending to the CMC with confirmed acquired immunodeficiency syndrome (AIDS) were screened. The patients were evaluated for social circumstance, family history, age, gender, clinical, and laboratory features. Clinical data including fever, respiratory distress, diarrhea, rash, etc. as well as laboratory tests including complete blood count, serum glucose level, electrolytes, liver function test, cultures, CD4 lymphocyte count were evaluated. During the study period, 32 HIV positive children were enrolled. The majority of patients were presented with weight loss, prolonged fever, respiratory infection and chronic diarrhea. In this study, salmonella infections as well as streptococcal pneumonia and candida infections followed by, tuberculosis and Pseudomonas aeruginosa infections were the predominant opportunistic infections. Since the number of HIV-positive children has been alarmingly increasing in recent years and perinatal transmission is the most common route of HIV infection in children, essential recommendations for prenatal HIV testing as well as appropriate antiretroviral therapy by HIV infected mothers are needed.

Oral manifestations in human immunodefi ciency virus infected pediatric patients receiving and not receiving antiretroviral therapy: a cross sectional study

The aim of the study was to assess and compare oral manifestations of human immunodefi ciency virus (HIV) infected pediatric patients undergoing antiretroviral therapy (ART) and those not undergoing ART. A cross sectional study included HIV positive children (receiving and not receiving ART) aged 5-15 years, registered at the District Hospital ART Centre, Udaipur, and HIV negative schoolchildren. HIV related oral lesions were diagnosed according to the World Health Organization criteria. Sociodemographic and other related information were also recorded. CD4+ cell count was determined in all study subjects. The χ2-test, stepwise multiple linear regression and logistic regression were used on statistical analysis. In all tests, confi dence interval and p-value were set at 95% and ≤0.05, respectively. A greater proportion of HIV patients receiving treatment had CD4+ cell count of more than 750 cells/mm3. The majority of HIV patients receiving ART for more than three years and only 20% of those not receiving ART were free from any oral lesions. The results of the present study demonstrated ART to be eff ective in reducing the prevalence of HIV related oral lesions, as already described in the literature; however, unlike previous studies, the present paper reports more valid fi ndings for having included most of the confounding variables.

English

To determine the gingival health of human immunodeficiency virus (HIV) infected children and how it correlates to CD4 percentages in vertically infected children with HIV undergoing combination antiretroviral therapy. Two hundred and fifteen HIV positive children on antiretroviral therapy, of both sexes from seven to fifteen years old were evaluated for their gingival status using the Gingival Index. Children were divided into three groups; mild, advanced and severe depending on their absolute CD4 count and CD4 percentage. Statistically significant association was observed between CD4% category (mild, advanced and severe) and gingivitis (P &lt; 0.001). More number of children in mild CD4% category were found to have mild gingivitis. Based on the results of our study the prevalence and distribution of&nbsp;gingivitis was high, this data will helps us in formulating a preventive as well as therapeutic programme for these children who have untreated oral lesions. &nbsp; Key words: Human immunodeficiency virus (HIV), gingivitis, antiretroviral therapy, oral lesions.

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

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.

Acquired epidermodysplasia verruciformis in an HIV positive child. Report of a case

Epidermodysplasia verruciformis (EV) is a rare genodermatosis whose main feature is a genetic predisposition to persistent skin infection by different serotypes of human papillomavirus (HPV). In recent years, an EV-like syndrome has been described in patients with impaired cell-mediated immunity, including patients with HIV. We report the case of a teenage female patient with congenital infection with the human immunodeficiency virus (HIV), which has similar lesions to classical EV.

Plasmablastic lymphoma of bone in a human immunodeficiency virus positive child – A rare extra-oral presentation

Abstract Plasmablastic lymphoma (PBL) is an aggressive variant of diffuse large B-cell lymphoma seen in patients infected with human immunodeficiency virus. Though PBL was initially recognized as oral lesions in HIV infected individuals, various extra-oral sites of affection have been described. In general, PBL has a dismal prognosis with most patients dying within 2 years of initial presentation. We report the case of a ten year old girl presenting with multiple bone lesions and hepatosplenomegaly. Histopathology and immunophenotyping was suggestive of PBL. ELISA for HIV 1 was reactive. Despite her advanced stage at presentation, she responded well to Highly Active Anti Retroviral Therapy (HAART) and six cycles of chemotherapy (CHOP). She is continued on HAART and is on follow-up for 38 months.

English

Intestinal parasitic infestations (IPI) are not uncommon in immunocompetent individuals. However, human immunodeficiency virus (HIV)-infected individuals with depleted immunity have an abnormally high susceptibility to infections. This study therefore, examines children with intestinal parasites according to HIV status and degree of immunosuppression. Consecutively consenting patients aged 1 to 15 years attending the Paediatric Clinic of acquired immune deficiency syndrome (AIDS) Prevention Initiative, Nigeria, were recruited as cases, while age and sex matched HIV negative controls were recruited from Out Patient Department of Jos University Teaching Hospital. Stool samples were examined for parasites by direct wet mount, formol-ether and modified Ziehl-Neelsen technique. Levels of immunosuppression were assessed amongst HIV-positive subjects. Five hundred and ten children aged 1 to 15 years equally divided between the two cohorts were enrolled for the study. Seventy-nine had IPI, giving a prevalence rate of 15.5%; 44 (8.6%) HIV positive and 35 (6.9%) HIV-negative children. The most prevalent extracellular parasite was Giardia lamblia, however HIV positives had significantly higher rate of G. lamblia infestation. Among the intracellular parasites, the infection rate in HIV-positive subjects (5.9%) was three times that in HIV-negative subjects (2.0%). HIV positive children with advanced and severe immunosuppression had significantly higher intracellular parasites. HIV status did not significantly predict the overall risk of having extracellular intestinal parasites however, it was noted that G. lamblia infection was significantly higher in HIV positive children. HIV positive children had higher risk of having intracellular parasites especially if they have advanced or severe immunosuppression. Therefore, the policy of screening children for intestinal parasites should continue irrespective of their HIV status. Those that are HIV positive children should specifically be screened for intracellular parasites. Key words: Intestinal parasites, HIV, Children, Prevalence, Immunosuppression.

Comparative evaluation of dental age, bone age, and chronological age in the human immunodeficiency virus positive children.

Background and Objective:The knowledge of bone age and dental age is of great importance for pediatrician and pediatric dentist. It is essential for pediatric dentist to formulate treatment plan and it is a source of complementary information for pediatrician. There are few studies in literature, which showed the relationship between dental age, bone age and chronological age in HIV-positive children. Therefore, objective of this study was to determine and compare dental age, bone age and chronological age in HIV-positive children.Materials and Methods:A total of 60 HIV-positive children between the age group of 18-14 years were selected. Chronological age was determined by recording date of birth. Dental age assessment was performed using orthopantamogram following the method described by Demirjian. Bone age estimation was carried out using hand-wrist radiograph following Bjork, Grave, and Brown's method.Results:Chronological age was advanced compared with dental age and bone age in both sexes. The correlation between chronological age, dental age and bone age were all positive in both sexes.Interpretation and Conclusion:The data supports the concept that dental age and bone age delay is a significant feature in HIV-positive children. It is important to consider dental age and bone age as variables for diagnosing growth retardation in HIV-positive children. To support our findings, further a well-designed, controlled as well as longitudinal study with a larger sample size is required.

Prevalence of hematological abnormalities and malnutrition in HIV-infected under five children in Enugu

Hematological abnormalities such as anemia, neutropenia, and thrombocytopenia occur in children infected by the human immunodeficiency virus (HIV). These abnormalities are due to myelosuppression caused by the HIV and contribute to the morbidity and mortality of HIV-infected children. Malnutrition is prominent in HIV-infected children due to associated conditions such as oropharyngeal candidiasis, diarrhea, and cytokine production which result in poor intake, nutrient loss, and increased metabolic rate, respectively. To determine the prevalence of hematological abnormalities (using the World Health Organization (WHO) case definitions) and malnutrition in HIV-infected children receiving care at the University of Nigeria Teaching Hospital, Enugu. The hematological and anthropometric indices of HIV-infected children between 18 and 59 months were assessed. Their hemoglobin level, neutrophil, and platelet counts were the hematological profiles evaluated using the WHO case definitions in HIV clinical staging. The weight-for-height z-score index was used to assess the nutritional status of subjects using the WHO reference ranges. The t-test, Chi-square, and Pearson correlation coefficient were used for statistical analysis. There were 67 HIV positive children: 34 males and 33 females, aged 18-59 months. The mean hematological levels of subjects were hemoglobin (Hb) 10.4 ± 1.2 g/dl, neutrophil count 3,031 ± 1,039 cells/mm 3 , platelets count 294 ± 78 × 109/L. Two children (3.0%) had anemia (hemoglobin < 8 gm/dl) and were severely immunosuppressed, on highly active antiretroviral therapy treatment and had advanced HIV disease (clinical stage 3). Children who were malnourished were 15 (22.4%). Hematological abnormalities and malnutrition occur in HIV positive children.

HIV and Hepatitis Infections in Children Resident in Orphanage Homes Located In Anambra State, Nigeria

Human immunodeficiency virus (HIV) and hepatitis infections are among viral infections transmissible among inmates of orphanage and motherless babies’ homes. Records are scanty on the prevalence of HIV and hepatitis infections in children resident in orphanage homes in Anambra State, Nigeria. This study investigated the prevalence of HIV and Hepatitis infections in children resident in eight orphanages in Anambra State. A total of 300 subjects consisting of 172 orphans, 100 children from community setting serving as controls, 14 female consented care givers in the orphanages and 14 females in community setting served as controls. All the subjects and control groups were investigated for HIV using rapid test and molecular technique. ELISA assay and liver enzyme estimation were used for Hepatitis investigation. The prevalence of 0.6%, 0.0%, 0.6%, and 9.9% were observed in HIV, hepatitis A, B and C respectively. Liver enzymes (serum alanine and aspartate amino transferases) did not show significant increase. The viral load and CD4+ count of the HIV positive child were 373 copies/ml and 28% respectively. Three (21.4%) of the care givers in the orphanages tested positive to HCV infection while none of the females in the community tested positive to the virus. HCV infections were most common in ages 0-5 years. The infection may be at dormant phase in the homes. Thus, continuous monitoring for progression into active hepatitis C infection is necessary for disease management in the orphanage homes.

Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: longitudinal study.

Use of Highly active anti-retroviral therapy have increased the life expectancy of human immunodeficiency virus (HIV) infected patients and hence it is imperative that all efforts have to be made by Pediatric dentists to provide a better oral health for these children. The aim of this study was to evaluate the rate of utilization of free dental treatment provided to these perinatally infected HIV positive children who were previously screened as a part of oral health survey. Purposive sampling was used. Perinatally infected HIV children screened for oral health status. Patients not screened during the oral health survey. Attendance records of 319 perinatally HIV infected children consisting of 178 males and 141 females attending a specialized pediatric outpatient clinic at Indira Gandhi Institute of Child Health were examined to compare treatment compliance rates. The number of patients in the severe category who completed treatment was significantly less compared with mild and advanced categories (P < 0.001). The difference in the proportion of patients who completed treatment between mild and advanced group was not statistically significant (P > 0.05). The results show that children with HIV have significantly lower compliance. Even though all dental treatment provided to them was free of the cost it still had no impetus to encourage them to go through with the treatment.

A case of plasmacytoma of scalp in pediatric thalassemia human immunodeficiency virus positive child

A 9-year-old female child, known case of beta thalassemia major and human immunodeficiency virus seropositive, presented with two slowly growing masses in the temporoparietal region of the skull on both sides. Irregular bony erosion at left parietal area with underlying scalp hematoma with similar change at the right side to a lesser degree were found. Fine needle aspiration cytology from masses showed abundant plasmacytoid cells some of which are binucleated along with free erythroblasts. Cytological features were suggestive of plasmacytoma. Serum protein electrophoresis showed no M-band. Urine was negative for Bence-Jones protein. Bone marrow biopsy showed no plasma cell neoplasm. Diagnosed as first reported case of primary multiple solitary plasmacyomas affecting bilateral temporoparietal bones in a pediatric patient, the child was treated with external beam radiation therapy to scalp lesions showing excellent results and on further follow-up showed no evidence of progressive disease.